UK High School Immersion Enrolment Form 2021

Student Enrolment Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date

DayMonthYear
Gender*
Nationality*
e.g. Spanish, German, Chinese
Primary Language
e.g. French, Catalan, Mandarin
Profile Photo of Student*

Upload a File

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ID or Passport Number*
ID or Passport Number*
Photocopy of Official ID*

Upload a File
Please provide a good quality photocopy Cancelof
Parent or Guardian's Name*

PrefixFirst NameLast Name
Parent's Contact Mobile Number*

Country CodeArea CodePhone Number
Student's Mobile Number*

Country CodeArea CodePhone Number
Family Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Next of Kin*

PrefixFirst NameLast Name
Relation to Student*
e.g. Mother, Father
Emergency Contact Mobile Number*

Country CodeArea CodePhone Number
Emergency E-mail*
Personal Requirements
Allergies (Animals, Food and medical etc)*
e.g. Allergic to dogs, allergic to dust mites, allergic to pencillin
Dietary requirements*
e.g. Vegetarian
Medication*
Please ensure you have arrangements made for all medications
Special Requirements*
e.g. Dyslexia, ADHD etc
Study Placement & Logistics
Number of years studying English*
Estimated proficiency*
Placement dates
Preferred School
Flight Arrival

DayMonthYearHourMinutesAM/PM Option
Arrival Airport
Arrival Flight Number
Carrier
Departure Flight Time

DayMonthYearHourMinutesAM/PM Option
Departure Airport
Departure Flight Number
Carrier
Do you require an unaccompanied minor service?

YesNo
Signature*
Print Name*

First NameLast Name
Should be Empty:

Student Enrolment Form

Personal Requirements

Study Placement & Logistics