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PARENTAL AUTHORISATION
FORM
For minors attending an EC adult course
This form is to be duly completed and signed by the parent(s) and/orlegal guardian(s)* for enrolment of students.

* A legal guardian is a person apointed by a court to have 		
custodianship over a minor. EC will need proof of legal 		guardianship

STUDENT GENERAL INFORMATIONPARENT/LEGAL GUARDIAN* 1

Full name

Full nameNationality

Home phone No.

GenderWork phone No.

Date of Birth

Mobile phone No.

Passport No.

Email Address

Date of Arrival

English Speaker?

Date of Departure

If no, what languages would you prefer to be contacted in?

Yes

No

Email Address
EMERGENCY CONTACT

PARENT/LEGAL GUARDIAN* 2

I/We understand that every effort will be made to contact me/us in the case ofan emergency, but if I/we cannot be reached, EC should contact:

Home phone No.

Full nameWork phone No.

Relationship

Mobile phone No.

Home phone No.

Email Address

Work phone No.

English Speaker?

Mobile phone No.

Yes

No

If no, what languages would you prefer to be contacted in?

Email Address

ACCOMMODATIONWill student be staying in EC Accommodation?

Full nameYes

No

If you answered “No”,
I/we understand and accept that EC will not be responsible any
way for his/her privately booked accommodation or other issues
that may arise related to his/her welfare inside the sameaccommodation.
All centres
Privately booked accommodation must be with a family friend or
relative over the age of 25 years.

If EC accommodation is not booked, please supply thefollowing information together with a copy of the passport ofthe person the student will be staying with.
Name and surname of person the student is staying with

What is the relation to the student

Please provide local address where student is residing

EC can only accept minors taking an adult course if they are staying in
an EC Homestay (single or twin room) / EC Residence for Young Adults(single) or if they are accompanied by one of their parents/ legal-guardian.
I hereby warrant that I will take full responsibility and personallysupervise the student outside lesson and/or activity times and thestudent will be accommodated at the address shown throughout thecourse dates.

Telephone No.
Email Address

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MEDICAL INFORMATION
It is recommended that students disclose any mental or physicalillness, allergy, disability or condition that may interfere with theirability to successfully complete their programme, that may impact
the wellbeing of any other student or staff member, that may requiremonitoring, treatment or emergency intervention during the student’s
period of enrolment, or that may require special accommodation.

EC will not discriminate based on any conditions mentioned (below) andwill provide reasonable accommodation to meet all students’ needs.

MEDICAL CONDITIONSIF YOU ANSWERED ‘YES’ PLEASE GIVE DETAILS

Does the student have any allergies?

Yes

No

Does the student have any medical conditions
that you feel we should be made aware of?

Yes

No

Does the student take any medication, either ona regular basis or as required?

Yes

No

Will the student be bringing medication with them?

Yes

No

Is there any reason why the student may notparticipate fully in activities?

Yes

No

To the best of my/our knowledge, my/our son/daughter is in a goodstate of health. Whilst all appropriate precautions will be taken forthe safety of my son/daughter, any loss, damage or harm to my son’s/
daughter’s person and/or personal belongings that may arise from theprogramme shall be exempt of all recourse.

If you replied “yes” to any of the questions, please give details (name ofmedication, reason for medication, dosage, frequency etc.)

Signature of Parent/ Legal Guardian*Date

DD | MM | YYYY

EC will endeavour to contact parents in case of any emergency.
However, should my son/daughter require medical treatment or
hospitalisation during his/her stay on this programme the attending
physician and/or hospital is authorised to treat my/our son/daughter.

ACCOMMODATION RULESyStudents must keep their room neat and tidyyStudents are not allowed to invite guests into EC accommodationyGirls are not allowed to stay in boys’ rooms and vice versayStudents are not allowed to smoke in any EC accommodationyStudents must not make excessive noise that could disturb otherguestsyStudents must pay directly for any additional services such as
phone calls/room serviceyStudents must return keys to reception/host when they areleaving EC accommodationyStudents must not allow anyone other than those allocated tothat room to sleep overy

Students are not allowed to sleep out even if their friends happen
to be at another EC accommodation

yCurfew times must always be respectedyParents/Legal Guardian are liable for any damages/breakages caused
to property by their son/daughter. Payment for damages must be
settled prior to student’s departure or legal action may be taken

EXPULSIONSEC reserves the right to expel and repatriate a student at his/her own
expense for any of the reasons noted below. This includes but is not
limited to the following circumstances:yPossession or consumption of any illegal drugsyPossession of weapons of any kindyAlcohol consumption / in excess of (according to local laws)y

Malicious damage to school property or accommodationyRepetitive disruptive behaviour in classy

Repetitive absenteeism from lessonsyRepetitive disregard for EC’s rules and regulationsyBreaking local lawsyViolation of Curfew Rulesy

If a student is a danger to his/her own safety or that of otherstudentsyBullyingTHIRD PARTY PROVIDERS
EC sometimes offers activities and excursions provided by 3rd party
providers on our activity calendar. These providers are selected
and endorsed by EC and we have approved their safeguarding andsafety policies. There will not be an EC representative present onthese excursions.

I/we give permission for our son/daughter totake part in activities and excursions arranged
and operated by 3rd party providers.

YesNo3 of 3

DECLARATIONAs the parent or legal guardian of the above-named student, I/wehereby give EC English Holdings Ltd. (and their respective agents,employees, volunteers, promoters and affiliates, all EC Centres)
permission to include this student on field trips/activities/excursions
accompanied by EC staff/representatives.
EC will take care of the above-named student. However, I/weacknowledge that accidents may happen during any of the services
offered by EC (excursions, activities, lessons, accommodation, etc)
and I/we accept that my family and I/we will not bring a claim against
EC for death or personal injury unless EC is shown to have failed tomaintain its duty of care.
I/we understand and accept that the EC staff and students will be
travelling on foot or by plane, train, bus, boat, car or van to theirdestination and that, though EC will give guidance and advice, thistravel will be unsupervised and at the student’s expense.

As the parent or legal guardian of the above-named student, I/we haveprocured for them such adequate insurance as may be required toprovide cover for the loss and/or damage to all the possessions theytake with them during any of the services offered by EC (excursions,activities, lessons, accommodation, etc) and that, in the event thatthey suffer loss and/or damage, I/we will therefore not make a claim
against EC for that loss and/or damage.
I/we understand that nothing in this waiver will limit any of the liability
EC may have for death or personal injury arising because of EC
negligence. I acknowledge that I/we have read this statement carefully
before signing this consent form and provide my permission to include
this student on any of the services offered by EC

ADULT CENTRES
I/We hereby authorise my/our son/daughter to attend the Adult
Programme and understand that this is a programme for studentsof legal adult age and over and of different nationalities. I/We also
understand that EC does not provide supervision and that theprogramme allows students to make their own arrangements during
free slots outside their lesson timetable.

CURFEW TIMES FOR STUDENTS AGED 16-17
I/We confirm that my/our son/daughter will follow and obey thestipulated Curfew Times.
yMalta:Sunday - Thursday – 11pm
Friday – Saturday – 12amyUK, Cape Town & Dublin:11pm

ADULT - UK CENTRES ONLY
I give permission for my son/daughter to attend weekend activities
and to go unsupervised on Saturdays and Sundays in the city.
Students must have written permission from a parent in advance ifthey wish to stay out overnight or go on a trip overnight. Students
will need to provide their own lunches, there are many places to buylunches with supermarket meal deals starting from £3.50. Students
need to return to homestay by 11pm.

yCanada:10pmy

New York, Boston:

11pm

y

LA, San Diego, San Francisco:

10pmONLINE SAFETY INFORMATIONCLICK HEREyI/We have read the information about online safety.

PHOTOGRAPHY AND FILMING
I/We give EC English Language centres the absolute right andpermission to publish, copyright, distribute and use pictures and/or videos of my child (or pictures taken by my child) for any purpose
which may include, among others, advertising, promotion, marketingand packaging for any EC product or service. I understand thatthese photos will not be used for anything other than EC marketing
purposes and agree that images may be combined with other imagesor footage, text and graphics, and cropped, altered and modified. If my/our child does not wish to be part of photo or video content it will betheir responsibility to absent themselves.

yI/We have discussed online safety with our child / ward andunderstand the process for reporting any violation of the EC
Online safety guidelines.

yI/We understand that my child / ward must attend the online
induction and failure to attend will result in a later start date

I/We have read and discussed the above guidelines with my/our son/daughter and acknowledge that he/she has agreed to follow theprogramme guidelines and further agree that the staff of EC reserve
the right to expel my child from the programme in the event of any
guideline violation.

Where there is more than one parent or legal guardian, the signaturesof both parents or all legal guardians are required.

Signature of Parent/ Legal Guardian*Signature of Parent/ Legal Guardian*Date

DD | MM | YYYY

Date

DD | MM | YYYY