Application Form

Online Application Form


Name of Person Completing This Application


Please Choose a Course*

Pre-A-Level/I.B. courses for students aged 15 – 17 years:

Dates for 2017 Weeks Course Fee GBP Course Code Please Tick
Monday 10 July-Sunday 3 September 8 £9,200 A1 A1
Sunday 23 July-Sunday 3 September 6 £6,900 A2 A2
Monday 10 July-Sunday 6 August 4 £4,600 A3 A3
Sunday 6 August-Sunday 3 September 4 £4,600 A4 A4
Sunday 23 July-Sunday 6 August 2 £2,550 A5 A5
Sunday 6 August-Sunday 20 August 2 £2,550 A6 A6

Pre-GCSE courses for students aged 13 – 15 years:

Dates for 2017 Weeks Course Fee GBP Course Code Please Tick
Monday 10 July-Sunday 3 September 8 £9,200 G1 G1
Sunday 23 July-Sunday 3 September 6 £6,900 G2 G2
Monday 10 July-Sunday 6 August 4 £4,600 G3 G3
Sunday 6 August-Sunday 3 September 4 £4,600 G4 G4
Sunday 23 July-Sunday 6 August 2 £2,550 G5 G5
Sunday 6 August-Sunday 20 August 2 £2,550 G6 G6

Junior academic courses for students aged 10 – 12 years:

Dates for 2017 Weeks Course Fee GBP Course Code Please Tick
Monday 10 July-Sunday 3 September 8 £9,200 J1 J1
Sunday 23 July-Sunday 3 September 6 £6,900 J2 J2
Monday 10 July-Sunday 6 August 4 £4,600 J3 J3
Sunday 6 August-Sunday 3 September 4 £4,600 J4 J4
Sunday 23 July-Sunday 6 August 2 £2,550 J5 J5
Sunday 6 August-Sunday 20 August 2 £2,550 J6 J6

Educational Background

Name of your Educational Agent

City

Present School

Present School City*

What will you do after the Summer Course?

Return to Home Country

Attend School in the UK

UK School (If known)

Entry Date

Year/Form

Course


Student's Details

Gender*

English Name

Family Name*

Other Names*

Date of Birth*

Nationality*

Passport Details

Passport Type

Number

Place of Issue

Expiry Date

Please tick here if you have not yet applied for a Passport

Please upload a copy of your passport here:

The file limit is 2MB (JPEG / JPG / PNG only)

Student's Present Address

Address Line 1*

Address Line 2*

Address Line 3

City*

Country*

Post/Zip code*

Email Address*

Mobile


Health and Welfare

Give full details here of any illness requiring special care, medication or diet information.

Has the doctor prescribed any medication for the student?*
YesNo (If yes, provide further information below)


Does the student suffer from allergies?*
YesNo (If yes, provide further information below)


Does the student suffer from asthma?*
YesNo (If yes, provide further information below)


Further Information

Parents' Details

Father's Family Name

Other Names

Fathers' Nationality

Mother's Family Name

Other Names

Mothers' Nationality

Parents' Address

Address Line 1*

Address Line 2*

Address Line 3

City*

Country*

Post/Zip code*

Parents' Telephone Numbers

Home(1)*

Office(1)

Mobile(1)*

Home(2)

Office(2)

Mobile(2)

Parents' Email Address

Email(1)
*

Email(2)


UK Contact in Case of Emergency

Title MrMissMrs

Family Name

Other Names

Email

Contact Numbers

Home

Office

Mobile

UK Contact Address

Address Line 1

Address Line 2

Address Line 3

City

Country

Post/Zip code


How did you hear about Etherton Education?

AgentEducation FairOur WebsiteFacebookUK SchoolOther

If other please specify


Pre-A-Level/Pre IB Course Only: Main Subjects

All students will study intensive English and Drama

Which subjects would you like to study during this course?
Please tick 3-5 subjects

PhysicsBiologyArt

GeographyTheory of KnowledgeChemistry

Business Studies/EconomicsHistoryPsychology

MathsFurther Maths

Any other subjects? (Please write the names)

Conditions of Enrolment

I have read and I agree to the Terms and Conditions.

1. I give permission for my child to attend all activities organised by Etherton Education Ltd during the course and I agree that my child will obey the Course Rules and English Law.
2. I also give Etherton Education Ltd permission to act on my behalf when dealing with a medical emergency.

I accept the Conditions of Enrolment