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The
participant:
Student's
first and last name
Nationality
Date of
birth
Starting
date of classes (Monday)
Ending
date of classes (Friday)
____________________________________________
The
parent/guardian:
I
undersigned:
First and
last name
Father Mother Person in charge
Address
agrees or
certifies the following points:
1/ For participants
under 18 years old in London
but NOT FOR
THE GROUP 12-14
"Learn English Performing Arts" that will be accompanied
everywhere at all times.
I
authorize the participant to travel ALONE on her/his own risk
(delete as needed)
°between
the airport/station and
the host family on
the days of arrival and departure. I do not take the optional
transfer service.
°between
the host family and the school address or meeting point (for
the language, tennis, cultural or any other
chosen programme as many times as required by the programme.
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2/ For
all participants:
I certify
that I will not hold responsible Christθle Le Lay neither Le Lay Language Consulting nor the organisations providing the
programme (language school, sports club, IAPA,
Compagnie Allegria or any other), nor the host family for
any accident on the participant's way between
their places or on their
premises encumbered or inflicted by the participant himself,
causing physical or material damage. I certify that the
participant is fully insured for any liability he may cause
anywhere, at any point during the programme and the name of the
insurance company is
I
understand that the organisations delivering the programme are
fully insured regarding their public and professional
liabilities during the hours on their premises. It excludes
therefore any participant leaving the premises unaccompanied and
/or unauthorized.
I certify
therefore that the participant is mature enough to respect the
programme's and host family rules: be on time for meals, be back
at 7:00 pm the latest, no going out unaccompanied after that
time.
I agree to
any medical or surgical attention deemed necessary. In case
these requirements are necessary I shall be informed as quickly
as possible. My emergency phone numbers are
I agree (rule out if you do not) that pictures and videos of the
participant may be taken and sent to the group of participants
or published on any promotional support related to the programme
including on the Internet.
Place:
Date:
Signature:
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