Your Name: Your Email Address: 1. I am applying to register my son/daughter for the 4 week Vacational Studies Course at The Mary Hare School (10 July – 7 August 2013): If your chosen House is no longer available, another House will be allocated. (For 16 – 18 year-olds only) My child would like to be considered for a House Captain role: Yes No (For 17-18 year-olds only) My child would like to be considered for a prefect role: Yes No 2. Student’s full name: My child has attended Vacational Studies previously and all details are as per my previous application (Please check at least one) Yes No
If “Yes” please go to section 21 or simply fill in any details that may have changed.
Name we should call him/her: 3. Date of birth: 4. Gender: Male Female 5. Nationality: 6. Name and postal address of Parent or Guardian: Phone: Mobile: Email: Fax: 7. Address during period of Course, if different from above: Phone: Fax: 8. Name and address of relative or friend (not partner) who may act on my behalf if I cannot be contacted: (You must answer this section) Phone: Mobile: Email: This person is a Relative Friend 9. Religion: If Catholic, is he/she obliged to attend Mass in England? Yes No 10. What foreign languages (except English) does he/she understand? 11. Assessment of his/her knowledge of English: Good Fair Poor None 12. Number of years studying English: (by July 2013) NEW STUDENTS ONLY (Please send a letter of recommendation from the school on behaviour and attitude to study.) See Note 1 The letter of recommendation can be sent later. 13. Invoice us for: (£) Complete only if you need an Invoice to send pocket money to us. (€) ($) for personal expenses (state the amount). (Personal expenses = pocket money + cost of theatre, if requested). Note: Personal expenses in £ Sterling can be sent bank-to-bank (preferred) or by cheque drawn on a UK bank in advance or be brought by the student. Personal expenses invoiced in € Euro or $ US Dollars can only be sent bank-to-bank. € euro and $ US Dollar transfers will be converted to £ Sterling before the Course begins. 14. Our acceptance is on the understanding that your child is in good physical and mental health and is able to function independently in a multinational community. Please disclose here any past/present health problems, allergies or behavioural factors of which we should be aware before acceptance: In the case of food allergies, the student must come with a 1ml. Adrenalin (Epinephine) 1:1000 injection pen an ‘EpiPen’. Students from EU and EEA countries should bring a EHIC card (European Health Insurance Card) to ensure free NHS medical treatment for all conditions. 15. Please list current vaccinations: 16. Brief description of his/her character, if not already known by us: 17. Favourite activities and sports and/or other information that may help us: I have access to the internet: Yes No 18. Can he/she swim? Yes No 19. Previous longest time away from home (in days): 20. Do you permit him/her to smoke at home? (please see 27) Yes No OPTIONS 21. OPTION 1: LONDON THEATRE Limited availability. Cost (show + travel) = £50 – £80. Add this to pocket money. Exact cost will be advised later. Choice of show will be advised later. Yes No OPTION 2: STRATFORD THEATRE ‘Hamlet’ at the RST 29.07.13. Very limited availability. Cost (show + travel) = £65. Add this to pocket money. Yes No OPTION 3: INSIDE BUCKINGHAM PALACE on 28.07.13. Very limited availability. Cost (entrance + travel) = £40. Add this to pocket money. Yes No OPTION 4: TRINITY EXAMINATION IN SPOKEN ENGLISH : £50 – £70 (depending on level.) Add this to pocket money. We shall decide the level and make the appropriate deduction. Yes No TRAVEL 22. He/she will USE FREE HEATHROW COLLECTION SERVICE * USE FREE HEATHROW RETURN SERVICE * BE BROUGHT TO SCHOOL BY PARENT/GUARDIAN BE COLLECTED FROM SCHOOL BY PARENT/GUARDIAN NEED SPECIAL AIRPORT COLLECTION ARRANGEMENTS ** NEED SPECIAL AIRPORT RETURN ARRANGEMENTS ** * Our free service applies to flights arriving at Heathrow Terminals 1, 3, 4 and 5 from 12.00-16.00 on 10 July and flights leaving Heathrow Terminals 1, 3, 4 and 5 from 10.00-13.00 on 7 August. UM tickets after 13.00 are excluded. We shall request flight details after we have received Course Fees. ** For students arriving at or leaving from Heathrow outside our stated dates or times, or flying on a UM ticket after 13.00, or who need to be met at other Heathrow Terminals, or if arrival/departure is at Gatwick. We shall request details later. PAYMENT OF COURSE FEES 23. If this application is accepted, when I receive your Invoice, I shall SEND FULL PAYMENT OF COURSE FEES IN £ STERLING IMMEDIATELY SEND 50% OF THE COURSE FEES IN £ STERLING IMMEDIATELY AND THE OTHER 50% IN £ STERLING BY 15 MAY 2013 (Option unavailable after 01.04.2013) SEND FULL PAYMENT OF COURSE FEES IN € EURO IMMEDIATELY (at the £:€ exchange rate on the date the first Invoice is sent) SEND 50% OF THE COURSE FEES IN € EURO IMMEDIATELY (at the £:€ exchange rate on the date the first Invoice is sent) AND THE OTHER 50% IN € EURO BY 15 MAY 2013 (at the £:€ exchange rate on the date the second Invoice is sent on 1 May 2013) (Option unavailable after 01.04.2013) SEND FULL PAYMENT OF COURSE FEES IN $ US DOLLARS IMMEDIATELY (at the £:$ exchange rate on the date the first Invoice is sent) SEND 50% OF THE COURSE FEES IN $ US DOLLARS IMMEDIATELY (at the £:$ exchange rate on the date the first Invoice is sent) AND THE OTHER 50% IN $ US DOLLARS BY 15 MAY 2013 (at the £:$ exchange rate on the date the second Invoice is sent on 1 May 2013) (Option unavailable after 01.04.2013) 24. T-shirt size (must be completed): S M L XL 25. I agree with the rules of the Course as set out in this web site and ‘Notes’ and accept that any breach of these will constitute a breach of contract. 26. I trust Vacational Studies to decide on the level of supervision required on trips and to permit visits and outings (if any) at its discretion. 27. I understand that smoking or possessing any smoking material is forbidden and will result in immediate expulsion and removal from the Course by me within 72 hours. 28. I understand that if for any reason not covered by our Insurance policy a student withdrawn from the Course less than fifty days before it begins, or fails to attend the Course, or leaves before it ends, no refund of Fees will be given unless a suitable replacement student accepts the place. 29. I understand that if any Fees remain unpaid fifty days after the date of the Invoice (unless otherwise stated on the Invoice), and if any Fees remain unpaid fifty days before a Course begins, acceptance of the student will be withdrawn and the place will be considered to have been cancelled. 30. I understand that Insurance is only as described on the Insurance 2013 information sheet. I accept the terms and agree to be bound by the conditions of the Insurance cover. I declare that my child is in good mental and physical health. 31. I agree to my and my child’s details being stored on Vacational Studies computer (they will not be passed on to any third-party) and accept that images of my child will appear on vacstuds.com. 32. I agree that my details may be disclosed to another parent for coinciding travel. I agree that my child’s details may be disclosed to other students for contact purposes. (If you wish to delete either or both sentences, contact us first). 33. If neither the undersigned nor the person in section 8 can be reached in an emergency, I consent to medical treatment being authorised by Ian G. Mucklejohn of Vacational Studies. 34. I agree to return the completed and signed ‘Agreement and Travel Details’ form by 6 June 2013. 35. I understand that English Law applies to all aspect of Vacational Studies. Office address:Vacational Studies, Pepys’ Oak, Tydehams, Newbury, BerkshireRG14 6JT, England. Telephone: (01635) 523 333 International: +44 1635 523 333 Fax: (01635) 523 999 International Fax: +44 1635 523 999 Bank address:National Westminster Bank, 30 Market Place, Newbury, Berkshire RG14 5AJ, England. A letter of recommendation may not be required if such a request might conflict with the policy of the school or government. Please state possible conflict. For payment of Course Fees and pocket money please see the Course Fees sheet: if letter for visa is needed Yes No
We will confirm by letter the details given. We suggest you print this form for your records before you press ‘submit’.