<p> 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</p><p>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 ……………………………</p><p> 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 </p><p> My child will be met on arrival in Newcastle by a representative of Yes No </p><p>International House (confirmation to be provided by school)</p><p> My child will be met on arrival in Newcastle by an adult family friend or relative Yes No </p><p>Name: …………………………………………………… Telephone number: …………………….. Address: ……………………………………………………………………………………………………. ……………………………………… Relationship to child: ……………………………………………</p><p> My child is arriving at an alternative UK port (not Newcastle) Yes No </p><p> If yes, please email IH with details of all connections and the adult supervision. ***************************************************************************************************** Accommodation arrangements International House accommodation </p><p> 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 </p><p>Private accommodation</p><p> My child will be met on arrival in Newcastle by an adult family friend or relative and will stay at their home Yes No </p><p>Name: …………………………………………………… Telephone number: …………………….. Address: ……………………………………………………………………………………………………. ……………………………………… Relationship to child: ……………………………………………</p><p>Signature of Parent/Guardian: ………………………………… Date: ………………………. Student Information</p><p>Name of student: ………………………………………………………………………</p><p>Emergency contact details For use in the case of an emergency situation while the child is in England</p><p>Parent or Guardian’s name: ……………………………………………………..</p><p>Address: ……………………………………………………………………………</p><p>………………………………………………………………………………………</p><p>………………………………………………………………………………………</p><p>Email: ………………………………………………………………………………</p><p>Telephone number: ………………………………………………………………</p><p>Additional telephone number: ……………………………………………………</p><p>Medical information</p><p>Date of your child’s last tetanus vaccination ………………………………….</p><p>Has your child ever:  suffered from any serious ailments or conditions? Yes No </p><p> had any mental, physical or behavioural problems? Yes No </p><p> had an allergic reaction to medication or anaesthetic? Yes No </p><p>If the answer to any of these questions is ‘yes’, please provide further details, including any medication your child is currently using.</p><p>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.</p><p>Signature of Parent/Guardian: ………………………………… Date: ……………………….</p>