Under 16 Programmes Enrolment Form

Parent:

Agent:

PERSONAL DETAILS

Family Name:

*

Given Names:

*

Date of Birth
(dd/mm/yy):

*

Sex: *

Male Female

Nationality:

*

Address:

*

City:

*

Country:

*

Telephone:

*

Fax:

Email:

*

Home/ Family Address:

*

Where did you hear about Worldwide's Under 16 Programmes?

COURSE DETAILS

Study
How many weeks will the child study?
(min 1 week, max 48 weeks)

*

Start Date:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year: *

ACCOMMODATION DETAILS *

I will make my own accommodation arrangments for the child
I wish the child to stay with a host family

Accommodation required:

From:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year:

To:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year:

For: Weeks

Can the child eat most foods? *

Yes No

Please give us details...

Does the child have any health problems or allergies?

Yes No

If YES, what are they?

YOUR INTERESTS:

What are their hobbies?

What sports do they play?

MEDICAL INSURANCE *

Do you want us to arrange medical insurance for the childs stay in NZ?
Medical Insurance is compulsory for all students to New Zealand. Information about Insurance in New Zealand can be found on the website. http://www.uni-care.org

Yes
No, will be arranged

Do you want the child to study more in New Zealand on completion of their Under 16 programme?

Yes No

If yes, where do you want them to study?