Summer School – Willow International Academy

Parent/Guardian Name *

First

Middle

Last

Biological Parent
Legal Guardian
Step Parent

Email *

Phone Number

Childs Name *

First

Middle

Last

Dropdown

Age of Child

Date of Birth

Address

Town

Post Code

In Case of Emergency Contact Information *

First

Last

Relationship to child *

Telephone Number *

Allergies *

Please give details of any Allergies

Medical Information *

Any other Medical Information we should know.

Dates Required *

Please specify your required dates, or if you wish to book the full 5 weeks.

Checkboxes *

I accept the above declaration

The information provided in this document is true, correct and complete. I have identified all parents and legal guardians for this student. The individuals identified in the “parent/legal guardian” section have the right to view student information and make educational decisions for this child, unless otherwise indicated here and supported with legal documentation.