Application Form: 2012; CHF 7,200.-

Student Details

Family Name (Required)

First Name (Required)

Gender (Required)

Boy
Girl

Date of Birth (Required)

-- 1995 1996 1997 1998 1999 2000 2001 2002 2003 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Religion (Required)

Nationality (Required)

MAILING ADDRESS, street, post-code/zip, country (Required)

Parent's/Guardian's Details

Family Name (Required)

First Name (Required)

ADDRESS during Summer School (Required)

Relationship to Student (Required)

Parent's E-MAIL (mandatory) (Required)

TEL (Home) (Required)

TEL (Office)

TEL (Mobile) (Required)

FAX

Parents' Marital Status (Required)

Married Separated Divorced Re-married Other

Language Lessons

Language to be studied : (Required)

English
French
German (beginner level only)
Spanish (beginner level only)

Level : (Required)

Beginner
Intermediate (French or English only)
Advanced (French or English only)

Number of years studying this language : (Required)

First Language (mother tongue) (Required)

If your child came to a previous Summer School, please indicate the language level attained during that programme below:

Activity Option Choices

In addition to following the varied activity programme, each child is given the chance to specialise in one activity of their choice during three activity sessions in the Summer School. Please state your child's preference of specialist activities (please mark their 1st, 2nd and 3rd choices) - we will try to ensure that your child is allocated to one of their choices). Please note that there will be little chance for your child to swap option activity during the Summer School, therefore it is important that they are happy with the choices they make in this application form.

First Choice of Activity (Required)

Performing Arts (a combination of Music, Dance and Drama) Art Rock Climbing Tennis (there is an extra 300 CHF charge for the tennis option) Sailing (there is an extra 300 CHF charge for the sailing option) Mountain Adventure (includes map-reading skills, flora & fauna identification, survival skills) Horse Riding (there is an extra 300 CHF charge for the horse riding option) Windsurfing (there is an extra 300 CHF charge for the windsurfing option) Team sports (football, hockey, volleyball, basketball) Kayaking

Second Choice of Activity (Required)

Performing Arts (a combination of Music, Dance and Drama) Art Rock Climbing Tennis (there is an extra 300 CHF charge for the tennis option) Sailing (there is an extra 300 CHF charge for the sailing option) Mountain Adventure (includes map-reading skills, flora & fauna identification, survival skills) Horse Riding (there is an extra 300 CHF charge for the horse riding option) Windsurfing (there is an extra 300 CHF charge for the windsurfing option) Team sports (football, hockey, volleyball, basketball) Kayaking

Third Choice of Activity (Required)

Performing Arts (a combination of Music, Dance and Drama) Art Rock Climbing Tennis (there is an extra 300 CHF charge for the tennis option) Sailing (there is an extra 300 CHF charge for the sailing option) Mountain Adventure (includes map-reading skills, flora & fauna identification, survival skills) Horse Riding (there is an extra 300 CHF charge for the horse riding option) Windsurfing (there is an extra 300 CHF charge for the windsurfing option) Team sports (football, hockey, volleyball, basketball) Kayaking

Other Information

I heard about Aiglon College Summer School from : (Required)

I would like to receive the main Aiglon College prospectus :

YES
NO

What size of t-shirt does your child wear? (Required)

Aged 9-11
Aged 12-14
Adult Small
Adult Medium
Adult Large

Has the student ever been expelled or suspended from any school or Summer Camp? (Required)

YES
NO

Please state the full name and year of graduation if you or any of your family are Aiglon Alumni.

Medical and Insurance Form

Is your son/daughter in good health? (Required)

YES
NO

Has your son/daugther been vaccinated against measles? (Required)

(If no, we recommend that your child is vaccinated prior to attending the Summer School)

YES
NO

Is he/she up to date with their tetanus vaccinations? (Required)

YES
NO

If so, what was the date of their last tetanus vaccination?

-- 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Has he/she been exposed to a contagious disease recently? (Required)

YES
NO

If Yes, which disease and when?

Is he/she allergic to anything? (Required)

(e.g. penicillin, antibiotics, aspirin, bee/wasp stings, strawberries, shell fish, etc.)?

YES
NO

If YES, what?

Does he/she suffer from asthma? (Required)

YES
NO

Does he/she suffer from hay fever? (Required)

YES
NO

Does he/she receive any medication? (Required)

YES
NO

Which medication?

For the treatment of:

Does he/she require any special diet? (Required)

YES
NO

If so, which foods should be avoided?

Can your child swim? (Required)

YES
NO

Can your child ride a bike? (Required)

YES
NO

What is your child's weight? (in kilos) (Required)

In the event that your child needs medical treatment and is prescribed drugs, it is useful for us to know your child's weight.

IMPORTANT !

Is there anything else we should know about your child's health or learning aptitude so that he/she can benefit fully from his/her stay at the Aiglon College Summer School?

Declaration

Confirmation (Required)

I agree that the information given above is correct. I understand that the discovery of false or incomplete information may jeopardize my child's right to a place on the course. I have read and understood the 'General Information' and 'Conditions of acceptance' (including the cancellation policy) as set out in the Summer School site and I agree to the terms therein. In the event of accident or emergency, I authorise the Director to take such action as may seem necessary at the time in question.

Today's date (Required)

-- 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Validation Section

Validation (Required)