StudentForm

Accommodation Application Form

Information will be used for Homestay Accommodation:

Bournemouth Homestay Accommodation

Personal Details

;

Student Name:

Student Surname:

Home Address:

Postcode:

Nationality:

Country:

Date of Birth:

Sex:

Telephone:

Mobile:

Email Address:

More About You

Do you have a Nick Name?

Do you smoke?

Hobbies and interests?

Accommodation Details

When will you arrive at the accommodation?

When will you leave the accommodation?

What type of room?

Are you okay to live with children?

Are you happy to live in a house with pets? (If No Why? Let us no in preferences below)

Are you okay to live in a house with smokers?

Do you have any other preferences?

We can not guarantee that we will be able to accommodate all your preferences.

Medical Information

Do you have any allergies? (e.g. dogs/cats/nuts.) if yes please state)

Allergy details:

Dietary requirements?

Dietary Needs Description:

Asthma, Bronchitis or Breathing Problems

Eczema or other skin disorders

Heart Conditions

Hepatitis A or B

Mental Health issues (e.g. depression, anxiety)

A disability that may effect your accommodation requirements

Any other known medical conditions, hearing disorders (e.g. Asperger's or autism)

Seizures, Epilepsy, fainting or blackouts

Severe headaches or migraines

Diabetes

Tuberculosis

Have you received any medical, surgical or psychiatric treatment in the last 3 years?

Do you take any medication?

Irritable Bowel Syndrome no medication needed

Tetanus, Diphtheria and Polio

MMR (Measles, Mumps and Rubella)

Meningitis

If you have ansewered Yes to any of the questions above please give details:

1st Emergency Contact Details

Name

Telephone:

Email:

Relationship:

Address:

2nd Emergency Contact

Name

Telephone:

Email:

Relationship:

Address:

Data Protection

All personal information that The Language Training co holds is processed in accordance with current UK data protection legislation. The Language Training co is the data controller and details can be found on website www.thelanguagetrainingco.com. The information you provide will be used for providing the services outlined in this document. Your data will be shared with your host, your parents and/or your agent where appropriate. We will contact you where necessary in order to provide the service detailed in this document. For more information about how we use your data, please see our full privacy notice here.

Declaration

Please agree and sign (After you sign in the box press the save button)

I confirm receipt of the Agreement for Students in Homestay Accommodation. I have read it in depth and I fully understand the implications of this document.You can find the agreement here.

I agree to receiving emergency treatment, including anesthetic, as considered necessary by the medical authorities present and for this information to be disclosed to relevant persons.

I confirm that to the best of my knowledge the information given on this form is correct.

Student Signature

Date

Parent/Guardian signature (if student is under 18)

Date

Additional Parent/Guardian consent for students under 18

Curfew Arrangements

As part of their course the students are required to work in the college’s ‘Escoffier’ restaurant until 22:30pm* one evening per week. Upon finishing, the students will then travel straight back to their host family accommodation with their peers.

*OUTSIDE OF THESE HOURS PLEASE NOTE THE COLLEGE CURFEW APPLIES – 16 YEARS 21:00, 17 YEARS 22:00

Parent/carer signature

Date

I give consent for my son/daughter to live in Homestay accommodation arranged by The College.

I give consent for my son/daughter to share a household with students of the opposite gender who are also under 18 years of age

I give consent for my son/daughter to share a household with a student over the age of 18 of the same gender

I give consent for my son or daughter to share a room with a student of the same gender who is under 18 years of age, but who may turn 18 years old during their stay(for shared room bookings only).

I give permission for my child to travel independently within the UK at her/his own, and my own risk and responsibility.This consent is for travel and overnight stays which have not been arranged by The College.I am aware that my son / daughter is required to share the details of his / her travel with The Accommodation Office and their host family prior to the event.

Consent9

If you have any queries, concerns or special requirements in regards to the above please contact the Accommodation Office.

Parent/Guardian signature (if student is under 18)

Date