Holiday programme 2013-2014

Holiday study Programme – Student Registration form Thank you for your interest in Aidan College. Please read the registration procedure attached before completing the form. For questions or assistance please contact Aidan College office. Tel : +41(0) 24 485 11 23 / Fax : +41 (0) 24 485 30 12 Email: info@aidancollege.ch Please write clearly and in printed CAPITAL LETTERS Family Name: _____________________________________ First Name: _____________________________________ Home Address: ________________________________________________________________________________________ _____________________________________________________________________________________________________ Home Tel: _________________________________ Student Mobile: ______________________________________ Email: _______________________________________________________________________________________________ Date of Birth: Day: _____ Month: ______ Year: _________ Place of Birth: ________________________________________ Nationality: __________________ Native Language: __________________ Second language: ___________________ Current school or college: __________________________________________ Current level / grade: ________________ OVERSEAS APPLICANTS: PASSPORT NUMBER: ________________________________________________________ Country: ___________________________________ Issue date: __________________ Expiry date: _________________ SWISS RESIDENT APPLICANTS: Commune of residence: __________________________ Canton: ________________ Emergency Contact Person to be contacted in an emergency: Name: _____________________________________________ Relationship to the student: __________________________ Telephone: ________________________________ Email: _____________________________________________________ Programme Requested ! Option 1: Intensive weekend workshop + online preparation ! Option 2: Intensive 5-day half-term break camp + online preparation ! Option 3: Super Intensive holiday boot camp + online preparation ! Option 4: Intensive 5-day half-term break camp only ! Option 5: Two weeks holiday boot camp only ! Option 6: Online tutoring only Number of hours required: ________ Have you already taken part in an SAT course? ☐ No ☐ Yes, please specify name of organization, location and length of studies: ___________________________________________________________________ !!University of Cambridge ESOL Examinations Please circle requested certification: KET / PET / FCE / CAE / CPE ! French (oral and written skills) ! TCF exam (when available) !!DELF / DALF, please indicate module: ___________________________ Number of years studied: ___________ Certificate or diploma obtained: _________________________________________ Have you already taken a language course? ☐ No ☐ Yes, please specify name of organization, location and length of studies: ____________________________________________________________________________________________ Academic and Exams Revision Type of courses required: ! Group conditions, please specify names of fellow students who will join your group of study: _____________________________________________________________________________________________________ Choice of subject courses: __________________________________________ Number of hours required: ________ __________________________________________ Number of hours required: ________ __________________________________________ Number of hours required: ________ __________________________________________ Number of hours required: ________ __________________________________________ Number of hours required: ________ Options (for the Academic and Exams revision programme only) ! Lunch ! Afternoon outdoor activities ! Weekend activities and / or excursion Dates Please carefully check dates of courses and indicate your choice of dates below for any programme requested: From ____________________ to ____________________ From ____________________ to ____________________ From ____________________ to ____________________ From ____________________ to ____________________ From ____________________ to ____________________ Health and Physique Summary Do you have any? ! Allergies ! No ! Yes ! History of anorexia or bulimia ! No ! Yes ! Knee, ankle, ligament problems ! No ! Yes ! Physical or mental disabilities ! No ! Yes ! Recurring or frequent illnesses ! No ! Yes ! Heart Condition ! No ! Yes ! Have you had any accidents or operations? ! No ! Yes ! Are you taking any general medication? ! No ! Yes ! Are you taking or have you ever taken cerebral stimulants or anti-depressants? (such as Prozac, Ritalin, Aderol, etc) If the answer to any of the question above is “yes” or if you suffer from any other conditions not listed, please give details of your conditions on an attached paper and ask your doctor to issue a medical certificate of no contraindication to the practice of sports activities. Signature of parents or guardian for underage students*: Date and place: ________________________ *By signing this form I agree to be bound by Aidan College’s Terms and Conditions and I understand that discovery of false or incomplete information may jeopardize my right to remain at the col ege.

Source: http://www.aidan-college-switzerland.ch/system/storage/69/3c/a/814/Holiday_Programme_registration_form.pdf