STUDENT DETAILSFull Name* Date of Birth* DD slash MM slash YYYY Age*Sex* Male Female Non-binary Phone number*Email address* Address in London PARENT / GUARDIAN DETAILSFull legal name of guardian* (mother/father/sibling/relative/legal guardian)24-hour contact number*Email address* Mother tongue* Level of English* Low Medium High Other languages Full home address* If the parent / guardian does NOT speak English, please give the details of a person that speaks English who can be contacted in an emergencyName Phone numberLevel of English Low Medium High Other languages spoken PARENT / GUARDIAN PASSPORT UPLOADUpload Parent/ Guardian PassportAccepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.PARENT / GUARDIAN DETAILS IN LONDON IF DIFFERENT FROM ABOVEFull legal name of guardian (mother/father/sibling/relative/legal guardian)24-hour phone numberEmail address Mother tongue Level of English Low Medium High Other languages London address PARENTAL CONSENTMy child / ward can:My child / ward can: stay in suitable homestay accommodation arranged by the school travel to and from the airport with a responsible delegate (age 7+) travel between the school and their accommodation with a responsible person (age 7+) travel between the school and their accommodation alone (age 14+ only) leave the homestay alone during their free time but return home before the curfew (age 14+ only) participate in leisure/sports activites inside and outside the school with responsible delegates (age 7+) participate in leisure/sports activities inside and outside the school with responsible delegates (age 7+) and I am aware that the school has iimplemented the appropriate safeguarding measures. ACCOMMODATIONDid Rose of York Language School organise your child / ward's accommodation?* Yes No Students must return home every evening (at the latest) by: Sunday to Thursday 18:00; Friday and Saturday at 18:00* Yes No *We may allow students to visit relatives in London, please contact us before arrival.If you want your child to arrive home before the above curfew, please choose the time:Sunday to Thursday (weekdays) Friday and Saturday (weekend) STUDENT HEALTHDoes he/she have any allergies?* Yes No Please give details* Does he/she have any conditions or illness that need medical treatment or medication?* Yes No Please give details* Is he/she taking any medication now?* Yes No Medicine Name Medicine formtabletsliquidotherDosage (e.g. 2 tablets, 10ml)How your child/ward takes the medication?by mouthby inhalerotherHow often your child/ward takes the medication?(e.g after breakfast and dinner, every four hours, as needed) I give permission for my child/ward to self-administer the medication named above under the supervision of a responsible delegate.* Yes No Does he/she have any special dietary requirements?* Yes No Please give details* Does he/she have any disabilities or learning difficulties?* Yes No Please give details* I agree to inform the school of any change in my child/ward's health before his/her arrival at the school.* Yes No Medical treatment in case of illness and emergenciesI agree that if my child becomes ill they should be attended by a doctor or hospitalised or operated on in an emergency if deemed necessary by a qualified doctor, and may be given medication according to a qualified doctor's advice in an emergency.* Yes No Rose of York is an inclusive school, committed to providing every student with a safe, supportive and enriching experience. To guarantee a positive and successful experience and the best possible environment for your child, we kindly ask that you provide the following information truthfully and in full.Has your child ever been diagnosed with any developmental, learning or physical needs, or have they received any additional support in school or with learning?* Yes No Please provide further details* Does your child have any mobility, vision or hearing difficulties or do they have any sensitivities to loud noise, light, textures or foods?* Yes No Please provide further details* Are there any situations that your child finds challenging (i.e. large groups, changes in routine) and is there anything we can do to help your child feel comfortable and supported?* Yes No Please provide further details* Additional information – Please provide any other relevant information about your child/ward.TRAVEL DETAILS - Flight DetailsArrival date Departure date Arrival time Departure time Arrival Flight number Departure Flight number Flying to (UK airport) Flying from (UK airport) Flying from Flying to I want Rose of York to organise a return taxi transfer service for my child / ward.* Yes No We strongly recommend that students aged 16 and 17 book a return airport taxi transfer service unless they are travelling with a named adult relative or guardian. If we DID NOT organise your child/ward’s arrival transfer (arrival to/departure from the UK), please choose one option below and give details: Public transport Tube Bus Coach Train Arrival Departure Name and contact number of person making the arrival transfer Name and contact number of person making the departure transfer Other Private taxi transfer Private arrangement Arrival Departure Name and contact number of person making the arrival transfer Name and contact number of person making the departure transfer By signing below, I agree to the following: Myself and my child are aware that my child cannot leave the building at any time. Myself and my child are aware that only students aged 14+ can travel to and from school unaccompanied. My child/ward will abide by the curfew (please see page 1 of this document). My child/ward understands and will follow the rules relevant to his/her stay in London. Any information I have provided about my child/ward’s health will be shared with their accommodation / teacher / group leader / doctors and other medical professionals where relevant. I give my consent for the school / homestay / group leader to act on my behalf in case of a medical emergency. I give the school / homestay / group leader permission to give my child/ward named medication when necessary. I am aware that there are adults studying in the building and that the school has implemented all the necessary safeguarding measures to ensure a safe environment: a staggered arrival, different break times and supervision during break times and pick up times. Rose of York reserves the right to use any photos or videos taken at the school or during social activities for marketing and promotional purposes.If you don't give consent to Rose of York to use your child's/ward photographs or videos please tick the following box. I don't give consent Parent / Guardian Name* Date* DD slash MM slash YYYY Parent / Guardian Signature*
