Application Form

2016 English for Education Summer Courses

We strongly recommend that students intending to study at a UK Boarding School attend for a minimum of 4 weeks,
preferably 6 or 8 weeks.
Our 2 week courses are taster courses only and should not be regarded as full preparation for study at a UK
Boarding School.

Pre-A-Level/I.B. courses for students aged 16 18 years:

Dates for 2016
Monday 11 July Sunday 4 September
Sunday 24 July Sunday 4 September
Monday 11 July Sunday 7 August
Sunday 7 August Sunday 4 September
Sunday 24 July Sunday 7 August
Sunday 7 August Sunday 21 August

Weeks
8
6
4
4
2
2

Course fee GBP

8,400
6,300
4,200
4,200
2,345
2,345

Course code
A1
A2
A3
A4
A5
A6

Please tick

Course fee GBP

8,400
6,300
4,200
4,200
2,345
2,345

Course code
G1
G2
G3
G4
G5
G6

Please tick

Course fee GBP

8,400
6,300
4,200
4,200
2.345
2,345

Course code
J1
J2
J3
J4
J5
J6

Please tick

Pre-GCSE courses for students aged 13 15 years:

Dates for 2016
Monday 4 July Sunday 28 August
Sunday 17 July Sunday 28 August
Monday 4 July Sunday 31 July
Sunday 31 July Sunday 28 August
Sunday 17 July Sunday 31 July
Sunday 31 July Sunday 14 August

Weeks
8
6
4
4
2
2

Junior academic courses for students aged 11 13 years:

Dates for 2016
Monday 4 July Sunday 28 August
Sunday 17 July Sunday 28 August
Monday 4 July Sunday 31 July
Sunday 31 July Sunday 28 August
Sunday 17 July Sunday 31 July
Sunday 31 July Sunday 14 August

Weeks
8
6
4
4
2
2

Educational Background
Name of your Educational Agent ___________________________________________ City _____________________________
Present School ____________________________________________ City ______________________ Year/Form NOW ______
What will you do after the Summer Course? Return to home country: Yes/No Attend School in the UK: Yes/No
UK School (if known) ________________________ Entry Date ______________ Year/Form _______ Course ______________

Students Details Girl

Boy

Date of Birth: Day ______ Month _____________________________ Year _________

Family Name ___________________________ Other Names ____________________________ English name _____________

Etherton Education Ltd| Tel: +44 (0) 1823 672388| Email: info@ethertoneducation.com| www.ethertoneducation.com
Registered office: Marlands, Sampford Arundel, Wellington, Somerset, TA21 9QU, UK

Nationality ______________________ Passport Type (British/EU/BNO/Chinese) ______________ Number _______________

Place of issue ____________________ Expiry Date ___________ Please tick here if you have not yet applied for a Passport
Students present full address ______________________________________________________________________________
___________________________________ City _______________________ Country ____________ Post/Zip code ________
Students email address ___________________________________ Students mobile _________________________________

Pre-A-Level/Pre IB Course Only: Main Subjects

Which subjects will you probably study in the UK?
Maths

Physics

Chemistry

Biology

All students will study intensive English and Drama

Please tick between 3 and 5 subjects:

Business Studies/Economics

Art
History
Geography Psychology Theory of Knowledge
Any other subjects? (Please write the names): _______________________________________________________________
Note: During the summer course you can choose which subjects you want to take.
It is a good chance to try a new subject if you are not sure whether to take it in your main school in September.

Health & Welfare Give full details here of any illness requiring special care, medication or diet information
Has the doctor prescribed any medication for the student? Yes
Does the student suffer from allergies? Yes

No If yes, provide further information below

No If yes, provide further information below

No If yes, provide further information below

Does the student suffer from asthma? Yes

Further information ______________________________________________________________________________________

Parents Details
Fathers Family Name (1) _________________________ Other names ________________Nationality____________________
Mothers Family Name (2) ________________ ________ Other names ________________Nationality___________________
Full Home Address: ______________________________________________________________________________________
_____________________________City _______________________Country_________________ Post/Zip Code____________
Phones: Home (1)_________________________ Office (1)__________________________ Mobile (1)_______________________________
Phones: Home (2)_________________________ Office (2)__________________________ Mobile (2)_______________________________

Email: (1) ______________________________________ Email (2) _______________________________________________

UK Contact (Guardian) during the course in case of emergency

Mr/ Mrs Family name _______________________ Other names _________________ Email _____________________________________
Contact address (full details) __________________________________________________________________________________________
Postcode: _______________________ Phones: Home __________________________ Mobile ____________________________________

Conditions of Enrolment Please read the following conditions carefully and sign below:
To be signed by the Parent or Guardian
I have read and I agree to the Terms and Conditions attached.

I give permission for my child to attend all activities organised by Etherton Education Ltd during the course and I agree that my
child will obey the Course Rules and English Law.

I also give Etherton Education Ltd permission to act on my behalf when dealing with a medical emergency.

Signed __________________________________________________________

Date ____________________

Please also print your full name in English: _________________________________________________________

Please complete both sides of this form and return it to Etherton Education with 10% deposit and a copy of the
students passport.
Etherton Education Ltd| Tel: +44 (0) 1823 672388| Email: info@ethertoneducation.com| www.ethertoneducation.com
Registered office: Marlands, Sampford Arundel, Wellington, Somerset, TA21 9QU, UK