Language
English (UK)
Spanish (Latin America)
Trips and Training Educational Study Trips
Program Identification
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University of Hertfordshire
Summer Programs UK Oxford Group
Winter Programs UK Oxford Group
Junior Programs Bournemouth UK
Summer Programs USA
Summer Programs Canada
Summer Programs Ireland
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Date of birth
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Address
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Parents e-mail
*
Parents name
*
Mobile Number
*
-
Country Code
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Area Code
Phone Number
Phone Number
*
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Country Code
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Area Code
Phone Number
Work Number
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Country Code
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Area Code
Phone Number
Passport details
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In the process of authorizing.
Argentinian.
Other nationality.
Duel passport holder.
State issuing country /ies for passport/s
Argentinian Passport number
Argentinian Passport expiry date .
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Year
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Educational School and or Institute attending.
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City or Area.
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English exams taken.
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CPE
CAE
FCE
PET
Flyers
Movers
Trinity Level 12
Trinity Level 11
Trinity Level 10
Trinity Level 9
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Trinity Level 1
None
Other
Health declaration
Please complete below:
Covid 19 declaration as at form completion. please select options.
fully vaccinated ( 4 dose administered )
fully vaccinated ( 3 dose administered )
fully vaccinated ( 2 dose administered )
not fully vaccinated (1 dose or none)
Blood Type
*
Please Select
O+
O-
A+
A-
B+
B-
AB+
AB-
Date of last anti -tetanus injection
*
date below
never
Do not remember
Date of injection administered
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Day
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Month
Year
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Do you suffer from any of the below? - please tick
Diabetes
Heart Condition
High blood pressure
Low blood pressure
Congenital heart disease
Hernia
Migraine
Constipation
Asthma
None of the above
Other
Have you recently had any of the following?
Hepatitis
A surgical operation
Depression
Stress related issue
Drug related condition
Mood swings
Allergies
None of the above
Other
Please list any medication you are being prescribed or are taking. List by drug type, dosage and frequency.
Medical file upload
Administered medication - please select
*
Please Select
Student administered
Administered by authorized adult
Administered by a medical doctor only.
Do you require a special diet
*
No
Yes - please give details below.
Please write below your dietary requirements
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