Parental consent form

Student Details

Full name of student*

First Last

Email*

Enter Email Confirm Email

Gender*

Male
Female

Date of birth*

Nationality*

Country

First language*

Passport number*

Passport expiry date*

First parent's or guardian’s details

Name*

Title First Last

Home Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Phone number (inc. country and area code)*

Relationship to child:*

First language*

Level of English*

Low
Middle
High

Second parent's or guardian’s details

Name

Title First Last

Home Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Enter Email Confirm Email

Phone number (inc. country and area code)

Relationship to child:

First language

Level of English

Low
Middle
High

Travel

I give consent for my son/daughter to travel to the UK and study at Newbold College of Higher Education.*

Yes
No

I agree that my son/daughter can travel unaccompanied to and from the College at the start and end of their course.*

Yes
No

Travel details: Flight no.

Airport

Time

Accommodation

I agree to my son/daughter staying in the Halls of Residence on the College campus.

Yes
No

He/she understands that he/she must follow the College and Halls of Residence rules*

Yes
No

If your son/daughter is staying with family members or is in accommodation arranged by yourself, please give full details:

Name of responsible adult in the accommodation

First Last

Date of birth

Relationship to child:

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Enter Email Confirm Email

Phone number (inc. country and area code)

Curfew times

I agree that my/son daughter must be in the Halls of Residence by 10.30pm*

Yes
No

Leisure activities

I give permission for my son/daughter to take part in any trips and activities organised by the College, under supervision.*

Yes
No

Unsupervised time

I give permission for my son/daughter to have free time for shopping on trips arranged by the College.*

Yes
No

I give permission for my son/daughter to have unsupervised free time in Binfield and Bracknell during the time between the end of classes (4.00pm) and dinner (6.30pm).*

Yes
No

I give permission for my son/daughter to have unsupervised free time after the evening programme (until curfew at 10.30pm).*

Yes
No

Medical

Please tell us about any problems. If we are not told in advance about a physical or mental condition, we reserve the right to terminate the student’s course.

Does your son/daughter have:

Asthma or bronchitis
Heart condition
Fits, fainting or blackouts
Severe headaches
Diabetes
Allergies to known medicines
Other allergies e.g. materials, food, plasters
Travel sickness
Any mental health problems (including eating disorders, hyperactivity)?

Is your son/daughter on regular medication?*

Yes
No

Does your son/daughter require regular hospital treatment?*

Yes
No

Does your son/daughter take any medication which he/she will bring with him/her?*

Yes
No

Is there anything else we should know about?*

Yes
No

If the answer to any of the questions above is YES, please give details:*

In case of minor pain or illness such as headache, mild cold or sore throat, do you agree to your son/daughter being given non-prescription medication such as Paracetamol, cough medicine, throat pastilles, antihistamine or travel sickness tablets?*

Yes
No

In case of an emergency, do you give permission for a responsible person at the College to arrange medical treatment? Of course, every effort will be made to contact you, the child’s parents/guardians, as quickly as possible.*

Yes
No

Attendance

I understand that students are expected to attend all scheduled classes/activities and be in their accommodation at the stated times.*

Yes
No

I understand that students are to behave and dress appropriately while attending classes and activities. Inappropriate behaviour will result in immediate exclusion from the programme.*

Yes
No

Photographs and video clips

I understand that the College may take photographs or video clips of students during class or leisure activities and that these images may be used in the College’s publicity or on its social media site.

I consent for images to be taken.*

Yes
No

I consent for images to be used in College’s publicity: Website*

Yes
No

I consent for images to be used in College’s publicity: Social Media*

Yes
No

I consent for images to be used in College’s publicity: Brochures and flyers*

Yes
No

Long-stay students (more than 3 weeks)

Details of student’s doctor in home country:

Name

Title First Last

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Enter Email Confirm Email

Phone number (inc. country and area code)

When did your son/daughter last have a tetanus injection?

I give permission for my son/daughter to be registered with a doctor (General Practitioner) in the UK.*

Yes
No

Consent

I confirm that the above details are accurate and complete.
I agree to the terms and conditions.
I have discussed the agreed arrangements and rules with my son/daughter.

Signature of the parent/guardian:*

I have discussed the agreed arrangements and rules with my parent/guardian.

Signature of the student:*

For students aged under 18

Data protection

Student Details

First parent's or guardian’s details

Second parent's or guardian’s details

Travel

Accommodation

Curfew times

Leisure activities

Unsupervised time

Medical

Attendance

Photographs and video clips

Long-stay students (more than 3 weeks)

Consent

Policies and Guidelines