Course enrolment form 2016

English Friends programme – enrolment form:

[contact-form][contact-field label=’Dates requested’ type=’select’ required=’1′ options=’19th – 26th June (10-14),19th June – 3rd July (10-14),19th June – 3rd July (Intensive course. Any age),3rd – 17th July (13-18),3rd – 24th July ( 13-18),5th – 19th July (13-18)’/][contact-field label=’Name’ type=’text’ required=’1’/][contact-field label=’Surname’ type=’text’ required=’1’/][contact-field label=’Date of birth’ type=’text’ required=’1’/][contact-field label=’Address’ type=’text’ required=’1’/][contact-field label=’Home Telephone’ type=’text’ required=’1’/][contact-field label=’My mobile’ type=’text’ required=’1’/][contact-field label=’My email’ type=’email’ required=’1’/][contact-field label=’Mum and dad´s mobile’ type=’textarea’ required=’1’/][contact-field label=’Mum and dad´s email address’ type=’textarea’ required=’1’/][contact-field label=’School/class and English exams taken’ type=’text’ required=’1’/][contact-field label=’What friend(s) would you like to be with in the same host family?’ type=’text’ required=’1’/][contact-field label=’Have you/any of your family been to Chester before? Give details’ type=’textarea’ required=’1’/][contact-field label=’Do you suffer from any medical condition/disability/allergy (including pets) or require a special diet?’ type=’textarea’ required=’1’/][contact-field label=’Hobbies’ type=’textarea’ required=’1’/][contact-field label=’Religion’ type=’text’/][contact-field label=’I agree to my son/daughter taking part in this study holiday.’ type=’checkbox’ required=’1’/][contact-field label=’I agree that should it prove impossible to contact me or my spouse, that my son/daughter’s group leader/ a senior member of Deva English staff, or the homestay adult (in that order of preference) may give consent for emergency surgery (in consultation with my son/daughter wherever possible).’ type=’checkbox’ required=’1’/][contact-field label=’I give permission for Deva English staff/families to administer over the counter medicine.’ type=’select’ required=’1′ options=’Yes,No’/][contact-field label=’I give permission for my son/daughter’s photo to be reproduced in promotional material.’ type=’select’ required=’1′ options=’Yes,No’/][contact-field label=’I give permission for my son/daughter to access the internet at school and the host family’s home (which may or may not have restricted access software).’ type=’select’ required=’1′ options=’Yes,No’/][/contact-form]

Please send a current photograph to