Student Information


Please note, you must be over the age of 18 to apply for this programme

All items marked with * are required.

First Name*:
Last Name*:
Date of Birth*:
Gender*: MF
Email*:
Tel*:
Fax:
Home Address*:
City*
State/Province*
Zip/Postal Code*:
Country* :


Do you have any special requirements we should be made aware of?

Dietary*: Yes No
If yes, please give details:
Medical*: Yes No
If yes, please give details:



Next of Kin Information


First Name*:
Last Name*:
Gender*: MF
Relationship to student*:
Email*:
Use same contact info as above (no need to re-type if checked)
Tel (Home)*:
Tel (Work):
Fax:
Home Address*:
City*
State/Province
Zip/Postal Code*:
Country* :



School/College Information (Optional)


Present School/College:
Address:
City:
State/Province:
Zip:


Extras


A deposit of $1000 must be paid within 7 days of this application - if not you will forfeit your place. Please follow instructions after 'Submit' to carry out this payment.

York Trip Addon - $350: No Yes
York Trip Single Room - $100: No Yes
Paris Trip Addon - $600: No Yes
Paris Trip Single Room - $100: No Yes

I have read the Terms & Conditions and Rules & Regulations