Student Application Form A1 Student Application STUDENT DETAILS (Appendix A) Student Name * Student Name First Name First Name Family Name Family Name Nationality * Date of Birth * Gender * Male Female Student's first language * Please select the course you wish to attend. The fully inclusive fee per student (excluding travel) is listed below course selection: * Course choice * Course 1 - Friday 8th July to Monday 1st August 2022 Cost of course: £5800 Course 2 - Friday 15th July to Monday 8th August 2022 Cost of course: £5800 PARENT/GUARDIAN DETAILS Title (Mr, Mrs, etc.) * First Name * Last Name * Relationship to student * Title (Mr, Mrs, etc.) First Name Last Name Relationship to student Home mailing address (Please fill in ALL lines/fields - type n/a if Not Applicable) * Home mailing address <i>(Please fill in ALL lines/fields - type n/a if Not Applicable)</i> Home mailing address <i>(Please fill in ALL lines/fields - type n/a if Not Applicable)</i> Home mailing address <i>(Please fill in ALL lines/fields - type n/a if Not Applicable)</i> City City State/Province State/Province Zip or Postal code Zip or Postal code Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country email: For all contact during GISS * A copy of this Application Form will be sent to this address. Confirm email: For all contact during GISS * Mobile no: For all contact during GISS * Alternative contacts in case of emergency We always try to reach parents first; in case we cannot reach you please give different contact details to the ones listed above. Name * Relationship to student * Mobile number * email * Name Relationship to student Mobile number email CHOOSE ONE STUDY CHOICE Study choices * English as an Addtional Language (for students who would like to improve their English) Information Technology Literature & Creative Writing International Citizenship Spanish Language (course 1 only) Please note: You will be asked to provide an assessment of your child’s ability at English or Spanish, if you have selected these, at a later date. CHOOSE ONE CLUB CHOICE Club choices * Football Photography Drama Outdoor Adventure Please let us know If the student has attended the summer school at Gordonstoun before, please state which year(s). If this application is made via an agency, please complete the agent information below: Agency Name Agent Title Agent First Name Agent Family Name Agent Tel No. Agent email: STUDENT HEALTH SECTION (Appendix B) Your application requires this medical form to be completed. Full disclosure of information is expected. All information will be treated in confidence and only shared with those who have direct responsibility for the care and well-being of the child. Should external medical support be required, some of this information may be required by the hospital and doctor. Here is a link to our Coronavirus Information. Is the student registered with a Doctor in the UK? * Yes No If yes, what is the Doctor's name and address: Special Dietary Requirements or Disorders Vegetarian Vegan Halal Food Allergies Eating Disorders / Issues Please provide further details for any boxes ticked above or for any other dietary issue of which you feel we should be aware of: Has the student experienced any of the conditions mentioned below? (Please tick all boxes that apply.) Hay Fever Dizziness / Fainting Rashes / Dermatitis Respiratory disease Immune disorder Autistic Spectrum Disorder Asthma Seizures Other allergy Repeated tonsillitis Diabetes ADD / ADHD Ear / hearing problems Bone or joint disorder Anxiety Frequest sore throats / colds Stomach problems Low mood Sinus problems Bowel problems Sleep problems Recurrent headaches Malaria or other tropical disease Substance abuse Thyroid problems Eczema Bereavement / loss Heart problems Drug allergies Kidney problems Other health issue Please provide further information for any boxes ticked above or for any other medical issue of whice you feel we should be aware: Please provide details of all regular medication taken by the student. Please note that ALL medication brought to the School MUST be shown to your child's House Parent. Name of Medicine Dose Frequency Purpose of medicine Name of Medicine Dose Frequency Purpose of medicine Name of Medicine Dose Frequency Purpose of medicine Anything else of which we should be aware of: Please provide details of your child's Tetanus immunisation history. Date of last Tetanus vaccination Medication is administered ONLY when strictly necessary and by qualified nurses or senior staff. These medications can be obtained from a pharmacy in the UK without requiring a prescription. If there are any medications from the following which cannot be given to your child, please advise PAIN RELIEF: Paracetamol * Yes, okay to administer No, do not administer PAIN RELIEF: Ibuprofen * Yes, okay to administer No, do not administer ANTIHISTAMINE: (e.g. Chlorpheniramine, Cetirizine) * Yes, okay to administer No, do not administer OTHER: Please specify Consent and Signature I understand that, in an emergency, every effort will be made to obtain my consent prior to an operation and/or the administration of an anaesthetic. However, should the school be unable to contact me, I hereby give my authorisation for the Director or Deputy Director to consent on my behalf. * I confirm Please confirm that you agree to Gordonstoun International Summer School retaining this personal data in compliance with the School's current GDPR policy,and that we may use this information as necessary to process this application. * I confirm Please confirm that you have read, understood and agree to to the Gordonstoun International Summer School Terms and Conditions. * I confirm I hereby certify that I have given, to the best of my knowledge, full and correct information about my child's physical & psychological health. * I confirm Name of Parent/Guardian completing this form * Name of Parent/Guardian completing this form First First Last Last Date * If you are human, leave this field blank. Submit application to GISS Δ