The Child Must Travel with a Copy of This Document

A copy of this signed document (both pages) should be sent to the school before the course starts. Please send to [email protected] Thank you. The child must travel with a copy of this document. 8 April 2018

To whom it may concern: International House Newcastle is accredited by the British Council and has been providing courses to English language students since 1978. I wish to confirm that my son/daughter is coming to the UK from ……………………… to attend a course of English language study at International House Newcastle. I understand and accept that International House does not supervise students aged 13 and over when travelling to/from school, homestay or events organised by the school. (The school provides relevant information and an emergency phone number. Host families advise on public transport routes.) Name of student: ………………………………………………………………………………………… Date of birth: ………………………………. Passport Number: ……………………………… Enrolment dates: …………………………. to ……………………………

 My child may appear in photos, videos and other promotional materials Yes No ***************************************************************************************************** Airport transfer arrangements  My child will be arriving at the following UK port of entry………………………………………… (e.g. Newcastle International Airport, London Heathrow, London Gatwick, etc.)  Flight number …………… Arrival time ………………  Unaccompanied Minor Service booked with airline? Yes No

 My child will be met on arrival in Newcastle by a representative of Yes No

International House (confirmation to be provided by school)

 My child will be met on arrival in Newcastle by an adult family friend or relative Yes No

Name: …………………………………………………… Telephone number: …………………….. Address: ……………………………………………………………………………………………………. ……………………………………… Relationship to child: ……………………………………………

 My child is arriving at an alternative UK port (not Newcastle) Yes No

 If yes, please email IH with details of all connections and the adult supervision. ***************************************************************************************************** Accommodation arrangements International House accommodation

 I have read and understood the homestay guide and/or Junior Homestay Programme Handbook and agree to these rules on behalf of my child Yes No

Private accommodation

 My child will be met on arrival in Newcastle by an adult family friend or relative and will stay at their home Yes No

Name: …………………………………………………… Telephone number: …………………….. Address: ……………………………………………………………………………………………………. ……………………………………… Relationship to child: ……………………………………………

Signature of Parent/Guardian: ………………………………… Date: ………………………. Student Information

Name of student: ………………………………………………………………………

Emergency contact details For use in the case of an emergency situation while the child is in England

Parent or Guardian’s name: ……………………………………………………..

Address: ……………………………………………………………………………

………………………………………………………………………………………

Email: ………………………………………………………………………………

Telephone number: ………………………………………………………………

Additional telephone number: ……………………………………………………

Medical information

Date of your child’s last tetanus vaccination ………………………………….

Has your child ever:  suffered from any serious ailments or conditions? Yes No

 had any mental, physical or behavioural problems? Yes No

 had an allergic reaction to medication or anaesthetic? Yes No

If the answer to any of these questions is ‘yes’, please provide further details, including any medication your child is currently using.

I declare that the above information is full and correct, and that I will inform International House Newcastle of any circumstances that may affect my child’s stay in Newcastle.

Signature of Parent/Guardian: ………………………………… Date: ……………………….