Consent form for students under the age of 18

(To be completed by parents)

1. Personal details

Student name
Yasmin Martins Fabosse
(nome do aluno)

Male or Female Feminino

(sexo aluno)

Date of birth
04/03/2006
(data de Nascimento)

Home address
Rua Dulce de Abreu Colombera,535, Marília -sp
(endereço)

Your name (parent 1)

Kleber fabosse
(nome pai)
Contact phone number
+55(14)996729016
(telefone contato pai)
Your name (parent 2)
Edneia Regina Martins Fabosse
(nome mãe)
Contact phone number
+55(14) 998760553
(telefone contato mãe)

Email Yasmin.fabosse@etec.sp.gov.br

Can parent 1 or 2 speak

English NO
(algum dos seus pais fala
inglês)
If you do not speak English,
please give the name and
number of someone we can
contact in an emergency
who does speak English Ingrid Martins Fabosse
(se seus pais não falam +55 (14) 99806-4431
inglês, por favor, escreva o
nome e contato de alguém
que fale inglês para
emergência)

2 Travel to the UK

I ___edneia ___regina ____martins_____Fabosse_____________give permission

for____yasmin______martins Fabosse
(nome do pai ou mãe) (nome aluno)

to travel to Oxford from London and to take part in an English language

course at Centre of English Studies. My son/daughter will travel to the UK on 19/01/2022.

V9
1
 Consent form for students under the age of 18
(To be completed by parents)

from GRU – Guarulhos To Madri Flight IB6824 and then from Madri To LGW – London flight
IB3714.
(Aeroporto saída Brasil / número do voo)

My son daughter will travel to Oxford in a taxi organised by the school

3 Travel in the UK
Is your son/daughter allowed to travel outside
YES NO
Oxford on supervised excursions within the UK?
Is your son/daughter allowed to travel outside
Oxford on unsupervised excursions within the
UK. This section only to be completed for 16
YES NO
and 17 year olds. Students under the age
of 16 may not travel on unsupervised
excursions
Is your son/daughter (under age 18) allowed to
go into Oxford/Wheatley in the evenings and at
YES NO
weekends unsupervised (subject to curfew
times)?

4 Travel outside of the UK (for students aged 16 and 17 only. Students under
16 may not travel unsupervised outside of the UK)
Is your son/daughter allowed to travel outside
the UK on unsupervised excursions? YES NO

Please provide contact details for where your

son /daughter will be staying when outside the
UK (name/address/phone number). If these
details are not yet known they must be supplied
to CES prior to your son/daughter travelling

5 Accommodation

I agree to my son/daughter staying in homestay YES NO

accommodation arranged by the school

He/she understands that he/she must follow the

homestay rules. Please see Supervision Notes
and Student Handbooks

I agree to my son/daughter staying in residential

accommodation arranged by the school YES NO

He/she understands that he/she must follow the

residential accommodation rules. Please see
Supervision Notes and Student Handbooks

V9
2
 Consent form for students under the age of 18
(To be completed by parents)

6 Medical information
Severe headaches NO
(fortes dores de cabeça)
Diabetes NO
Does your son or daughter
Allergies to medicines
suffer from any of the NO
(Alergia a medicamentos)
following?
(seu filho ou filha possui Asthma or bronchitis
algumas das condições de YES
(Asma ou bronquite)
saúde descritas ao lado?)
Heart condition
NO
(condição cardiáca)

Fits, fainting or blackouts

NO
(convulções ou desmaios)

Other allergies e.g. materials,

food, plasters NO
(outras alergias)

Any mental health issues

(alguma condição de saúde NO
mental)

Eating disorders or
hyperactivity
NO
(distúrbios alimentares ou
hiperatividade)

Travel sickness NO
(enjoo em viagens)

Does your son or daughter

have any other medical
conditions? Please give
details.
(seu filho possui alguma outra
condição médica? Se sim, No
detalhe)

Does your son or daughter

need a special diet (e.g.no milk
or dairy)? If yes, please give No
details
(seu filho possui alguma dieta
especial?)
No
Is your son or daughter taking
any medication?

V9
3
 Consent form for students under the age of 18
(To be completed by parents)
If ‘YES’, please list medication
here and how it should be
taken and if he or she will bring
medication to the UK
(seu filho utiliza alguma
medicação? Se sim, qual? Ele
levará essa medicação para o
Reino Unido?)

Is there anything else we

should know about? No
(Você possui alguma
informação extra para
detalhar?)

If your son or daughter has any medical problems, it is very important that you tell us all the details
so that we may look after him or her. We have to share this information with their homestay hosts
and other members of CES staff. Do you give CES permission to share the details on this form with
homestay hosts and other CES staff members?

YES NO
Please note, if you do not give us permission to share these details it may mean that we
cannot allow your son or daughter to study with us.

7 Publicity, photos and social media

Sometimes we like to take photos of our students for publicity and to show other students the type
of activities they can do when studying with us. We also like to post photos on social media pages
about our activities. These will often contain images of our students. We can and will only do this if
we have your permission to do so. Please note that if you do not agree, this will not affect your son
or daughter or their study with us. Do you agree that CES can take photos of your son or daughter
that may be used in CES publicity or stored on CES social media sites

YES NO

8 Use of emails for promotional purposes

We collect your email address in order to contact you if there is a problem with your son or
daughter. In addition, we may send you details of CES promotions and special offers. Do we have
permission to use your email for this purpose?

YES NO

9Levels of supervision
CES will supervise your son or daughter as much as possible. However, we are unable to
supervise all students 24 hours a day. In the declaration we ask you to sign that you understand
there will be occasions when your son or daughter is not supervised by us, e.g. walking to and from
school (when not using the CES shuttle bus) or walking to and from certain activities in the
evenings or weekends. PLEASE READ THE SUPERVISION NOTES THAT WE HAVE SENT
YOU IN ADDITION TO THIS DOCUMENT

V9
4
 Consent form for students under the age of 18
(To be completed by parents)

10 Acting ‘in loco parentis’

In the event of a medical emergency, If I cannot be contacted by the school, I give permission to
the responsible CES staff to take the necessary actions as advised by medical practitioners.

By signing this form you agree to the above

11 Risk assessments for unsupervised travel (in the UK or outside of the UK)
If you have answered yes to allowing your son or daughter to travel unsupervised within the UK or
outside the UK, we will conduct a risk assessment with them before they go and we will send you a
copy of the risk assessment

12 Data Protection
I understand and agree that Centre of English Studies will collect and use personal information
about your son/daughter provided by you. We hold all of their personal information securely and
only those with a legitimate interest who need to access it will be permitted to. Only some contact
details will be passed on to third parties, e.g. their homestay family. We do this for their health and
safety. We hold and use their information to help them study and learn, to check and to report on
how well they are doing and to make sure they are happy and safe with us. Please refer to our
website to see our full Data Protection Policy. By signing below you agree to us collecting and
storing your(and your son’s or daughter’s) data

Declaration

I confirm that:

1 I have completed all details in the above form honestly, truthfully and accurately
2 I understand that my son or daughter will be unsupervised at times during their stay in
the UK
3 I have provided all medical information necessary
4 I have read, understood and accepted the terms and conditions below
5 I have read, understood and accepted the supervision notes
6 I understand that if my son or daughter does not follow the school rules, he or she may
be asked to leave the school and return home at my expense.

Print name
(nome Edneia Regina Martins Fabosse
completo)

V9
5
 Consent form for students under the age of 18
(To be completed by parents)

Sign name
(assinatura)

Date 19/12/2022
(data)

Please read the following information carefully. You do not need to send the
following information back to us.

Terms and Conditions

 All students under the age of 18 are offered shared room accommodation as standard.
We do not provide single rooms for students under 18.
 Students with special dietary or medical problems are accepted solely at the discretion

V9
6
 Consent form for students under the age of 18
(To be completed by parents)
of CES. There is a supplementary charge for coeliac, lactose intolerance, vegans and
students with special dietary requirements. Parents must complete in full and return
this consent form to CES in the UK before any booking can be considered confirmed.
 CES cannot accept students with enuresis (bed-wetting).
 CES will do everything reasonably possible to meet student’s accommodation requests.
 Students are expected to follow school rules and failure to do so may result in your son
or daughter being sent home at your expense. This will be at the discretion of CES UK.
 CES does not accept students aged 18 years and over on Junior courses. We reserve
the right to refuse such bookings.
 CES reserves the right to charge a student £50 for an unnecessary change of
homestay.
 All students are expected to bring a towel and toiletries with them.
 Students who are aged under 18, must obey the CES rules for Junior students.
Students who take alcohol or drugs will be sent home immediately at their parents'
expense. There will be no refund of fees for such students. Agents will be advised of the
expulsion and must make arrangements for their student(s) to return home immediately.
 Students aged under 18 must follow the rules regarding supervision and curfew times,
as written in handbooks and supervision notes for parents.
 Students studying at the Junior centre may have classes in the morning or in the
afternoon, at peak times during the year.
 CES do not provide classes on national bank holidays. There are no extra classes
given where a bank holiday occurs during a course.
 CES has a strict anti-bully policy regarding all forms of social media. Any student found
breaking this rule can be sent home
 Failure to disclose medical information, information about medicines that need to be
taken, or failure to complete the CES consent form may result in your son or daughter
being sent home at your own expense.
 Failure to sign and return this form when asked to do so may result in problems with
your booking.

V9
7