Online registration

Pocklington School - Action in English venue

ONLINE REGISTRATION FORM

To reserve a place please complete and submit the following form, then submit your credit or debit card details on our secure page. We also accept payment by fax or phone on +44 (0) 114 275 1602, or sterling cheque by post.

Deposit
A deposit of GBP 250 per child is required to secure a place on the camp. This payment must be made via our secure page or via a BACS transfer within 10 days of submitting the registration form. The deposit is refundable (minus a 15% administration fee) only if a child is not able to attend the camp due to visa refusal, illness or injury, in which case relevant certification must be provided.

Please complete a separate registration form for each child

Family Name

First Name

Boy Girl

Name by which he/she likes to be called

Date of Birth (day/month/year)

Nationality

Mother tongue

Desired course dates

Parent/Guardian Names

Relationship to student

Address

Telephone

Alternative telephone number in case of emergency

Your email address

Student's email address

Can we put you in contact with other parents so that students can travel together?

Yes No

How would you describe your child's level of English?

Are there any particular aspects of English you would like your child to concentrate on?

If there is a choice, do you prefer your child to be placed in a class

By age? By ability?

Can your child swim?

Yes No

Does your child have any existing medical issues we should be aware of (please include allergies)?

Does your child have any special dietary requirements? If so give details.

Please describe your child's personality

Where did you hear about Action in English?

May we use photos of your child whilst studying or during sporting activities for publicity material?

Yes No

I declare to the best of my knowledge that my child is in good physical and mental health. In the event of illness or injury, I agree to my child receiving treatment from the attending medical practitioner

Yes No

Terms & Conditions

Accept

I declare that the information I have submitted is true and correct

ACTION IN ENGLISH +44 (0)114 275 1602 info@actioninenglish.co.uk
Company Number 7172587