Application Form - 11th to 21st July; CHF 4,200.-

Student Details

Family Name (Required)

First Name (Required)

Gender

Boy
Girl

Date of Birth

Please note that the Super Summer School is for children aged 16 - 18.

-- 1992 1993 1994 / -- 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

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

Parent's/Guardian's Details

Family Name (Required)

First Name (Required)

Relationship to Student (Required)

ADDRESS during Super Summer School (Required)

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

Tel (Home) (Required)

Tel (Work)

FAX

Tel (Mobile) (Required)

Parents' Marital Status (Required)

Married Separated Divorced Re-married Other

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?

Aged 10-12 Aged 12-14 Adult Small Adult Medium Adult Large

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?

-- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 / -- 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 so, 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 so, which one(s)?

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

Validation (Required)