Booking Form – Heritage Summer Camps

Please complete the form below making sure all * fields are completed. Once the form is submitted we will then contact you to outline the payment options, which will then complete the registration process for your child/children.

Heritage Booking Form

Name of Child

Name of Child

First

First

Last

Last

Preferred Name

Date of Birth

Sex

Nationality

Passport Travelling On ….

Native Language

Languages Spoken?

Level Of English

Current School

Which Course

Course Length

Mother Name

Mother Name

First

First

Last

Last

Father Name

Father Name

First

First

Last

Last

Address of Main Contact

Phone Mother (inc country code)

Phone Father (inc country code)

Email Mother

Email Father

How Did You Hear About Us?

Name of Agent

Does Your Child Have Allergies?

Please Give Details…..

Does Your Child Have Any Dietary Requirements?

Please Give Details……

Are There Any Other Medical Issues We Should Know About?

Please Give Details……

Do We Have Permission To Administer Paracetamol?

Name of Guardian?

Name of Guardian?

First

First

Last

Last

Email Guardian

Phone Guardian (inc country code)

Visa Required?

Passport Number

Date Of Issue

Date Of Expiry

Method Of Payment

Promotional Code (if any)

Name

Name

First

First

Last

Last

Date

If you are human, leave this field blank.