Parental / Guardian Consent Form – students aged under 16 This form must be completed by the parent/guardian of any student aged under 16 years old applying for a place on an English course at the school.STUDENT DETAILSFirst name* Last name* Date of Birth* DD slash MM slash YYYY Age*Sex* Male Female Non-binary Phone number*Email address* Course start date DD slash MM slash YYYY Course end date DD slash MM slash YYYY PARENT / GUARDIAN DETAILSTitle*Mr.Mrs.Ms.First name* Last name* 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 DETAILS IN LONDONTitleMr.Mrs.Ms.Full name 24-hour phone numberEmail address Mother tongue Level of English Low Medium High Other languages Address PARENTAL CONSENTMy child / ward can:My child / ward can: stay in suitable homestay accommodation arranged by the school (age 14+) travel to and from the airport with a responsible delegate (age 8+) travel between the school and their accommodation with a responsible person (age 8+) 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 8+) 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.The child's FULL address in London Host's full name Host's email address Host's home phone numberHost's mobile phone numberSTUDENT 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 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 Additional information - Please use this space to tell us other relevant information about your child/ward.By signing below, I agree to the following: My child/ward will abide by the curfew. My child/ward understands and will follow thw 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 were 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. Rose of York may use any photos or videos taken at the school or during social activities for marketing and promotional purposes.I give permission to Rose of York to use my child's/ward's photographs or videos for Rose of York Language School's promotional material and publications.* Yes No I hereby confirm that I am the parent/legal guardian of the applicant.Parent / Guardian Name* Date* DD slash MM slash YYYY Parent / Guardian Signature*