EmailMe Form - Application Form

Full name of student: *

First Last

Gender *

Male

Female

Preferred name:

Date of birth: *

DD / MM / YYYY

Present Year of Study: *

Present School: *

Nationality: *

Enrolling for Year: *

Passport Number: *

FATHER/GUARDIAN

Father/Guardian (Name in full): *

First Last

Occupation: *

Address: *

Business Phone: *

Home Phone: *

Email: *

Fax Number:

MOTHER/GUARDIAN

Mother/Guardian (Name in full) *

First Last

Occupation *

Address (If different from father)

Business phone: *

Home Phone: *

Email *

Fax Number:

THE PARENTS OR GUARDIANS OF THE INTERNATIONAL STUDENT ARE REQUIRED TO COMPLETE AND SIGN THIS DOCUMENT.

I/We accept that our child shall be subject to the rules and regulations of Cambridge High School.

Name/s: *

Signature/s:
(Sign on the line below by using a mouse or stylus.) *

Clear

Sign on the line by using a mouse or stylus.
Click on the "CLEAR" button if you are not satisfied with the signature.

I/We are the: *

Father and Mother

Mother

Father

Other Person

If Other Person, please state your relationship to the student.

Period of study.

From:

MM / DD / YYYY

To:

MM / DD / YYYY

Subject Choices (in order of preference). *

Subject 1
Subject 2
Subject 3
Subject 4
Subject 5
Subject 6

Hobbies / Sports / Special Interests *

Career Plans *

Upload passport photo *

STUDENT HOMESTAY REQUIREMENTS

MUST BE COMPLETED BY PARENT IN CONSULTATION WITH STUDENT.

How many brothers do you have? *

How many Sisters do you have? *

Age(s) of Brother(s) *

Age(s) of Sister(s) *

Do you play any musical instruments? *

Yes

No

If so, which instrument?

Would you like other children in your homestay? *

Yes

No

Would you like children younger than 12 in your homestay? *

Yes

No

Would you like children that are 13 years and older in your homestay? *

Yes

No

Would you like a family with more than four people? (Mother, father, 2 or more children) *

Yes

No

Would you like a family where another international student of a different nationality to yourself lives? *

Yes

No

None of the above, I require a homestay without children. *

Yes

No

Do you want to stay in Cambridge town? *

Yes

No

Do you want to stay in the countryside? *

Yes

No

Do you have an allergy to pets and/or animals? *

Yes

No

Would you like a homestay with pets? *

Yes

No

Will you bring a laptop computer with you to use at your homestay? *

Yes

No

What foods do you like to eat? *

Are there any foods you do not eat? *

Do you have any special requirements of your homestay family? *

Cambridge High School will endeavour to match the student homestay requirements with a homestay family subject to availability; however in some cases not all requirements will be able to be met.

HEALTH DETAILS - Medical Information

Rheumatic fever *

Yes

No

Epilepsy *

Yes

No

Hepatitis A or B *

Yes

No

Glandular fever *

Yes

No

Asthma *

Yes

No

Bee/Wasp Allergy *

Yes

No

Heart condition *

Yes

No

Diabetes *

Yes

No

Allergic reaction to: *

Medication required: *

Other medical condition or disability including mental health issues, physical disability, violence or abusive behaviour or any additional needs that the school should be aware of? *

Does the student have a physical condition that might affect classroom learning eg: hearing loss, need for glasses, motor skills loss etc. *

Yes

No

If yes, please explain.

Date of last Tetanus injections: *

MM / DD / YYYY

Date of last Measels injections:
(Please send in a copy of your vaccination certificate) *

MM / DD / YYYY

Document/File Upload