Please complete this form in as much detail as possible. We will need this information to be able to process your application for a place for your child on our immersion programme. If you do not complete the mandatory sections in full we will not be able to confirm the booking.

Information which is mandatory for you to provide is indicated in the form by an *

For further information about how we may use your and your child's personal information please read our Privacy Policy.

Your child's details

Name

First

Last

Gender

Female
Male

Date of birth

Home address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Current school

First parent or guardian details

We will use this contact in case of an emergency

Title

Name

First

Last

Relationship to child

e.g. father, mother

Home address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email address

Phone number

Second parent or guardian's details

Title

Name

First

Last

Relationship to child

e.g. father, mother, aunt

Home address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email address

Immersion Programme Period

We offer two- and three-week immersion programmes for children aged 3 - 11 at Heathside School Hampstead

Please select dates below

From

To

Information about your child

your or is

Does your child have any medical conditions or allergies we need to be aware of?

If yes, please specify below.

Does your child have any learning difficulties, behavioural issues or disabilities?

If yes, please specify below.

Please note that we may ask for further information about any of the details you include in the boxes above.

In the box below, please provide any additional information you consider important for us to know about your child. If there is none please write 'not applicable'.

Declarations

By completing and submitting this booking form, I/we declare that:

I/We have read and agree to the terms and conditions of the Heathside School Hampstead Immersion Terms and Conditions.
I/We have read the Heathside School Hampstead Privacy Policy published on the school's website.
I/We understand that places on the Immersion Programme are subject to availability and to me/us providing full disclosure of all information requested by the school.
I/We understand that a legally binding agreement between Heathside School Hampstead and me/us will be formed when I/we receive an electronic confirmation after submitting this online booking form and paying the programme fees.
I/We agree that all declarations made are accurate and true, and any misleading declaration will result in the termination of any contract between Heathside School Hampstead and me/us.

British Immersion Programme

Your child's details

First parent or guardian details

Second parent or guardian's details

Immersion Programme Period

Please select dates below

Information about your child

Declarations

Heathside Bright Minds Event