Parental / Guardian Consent Form – students aged 16 or 17 This form must be completed by the parent/guardian of any student aged 16 or 17 applying for a place on an English course at the school.STUDENT DETAILSFirst name* Last name* ID/Passport No. 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 PARENTAL CONSENTMy child / ward can:My child / ward can: travel to and from the airport alone travel to and from the airport alone study in classes with students aged 18 and over be placed in homestay accommodation which may have guests aged 18 and above participate in our social events programme with our activity leader(s) organise their own free time outside school hours but return home before the curfew 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 10:00pm; Friday and Saturday at 11:00pm 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*
