Premium Care

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Student details

First Name *

Last Name

Date of Birth *

Gender
MaleFemale

Nationality

Passport Number/ID

Email address *

Phone number *

Current Education

Name of School/ University

Address of the School / University

Town

P.O. Box

Next of Kin

Kin No 1

First Name *

Middle Name

Last Name *

Email address *

Area of Residence *

District *

Town *

Village

Street *

Kin No 2

First Name

Middle Name

Last Name

Email address

Area of Residence

District

Town

Village:

Street

Medical History

Dietary Requirements/Allergies

Medical condition/Learning difficulties

Would you be interested in signing up the child on The CareMedical Insurance *
YesLater

Travel Details

Booking Date

Arrival Date

Arrival time

Flight/Bus details

School Placements

Education level
PrimaryO-LevelA-LevelUniversity-Short course-Undergraduate-Master’s Degree

First choice of school/university

Skills/Talent preferences

Career/Course preferences

School gender type
Boys onlyGirls onlyMixed

School/University start date

Particular school/university facilities required

Tick factors which are most important to you
School/university locationSize of school/universitySchool/university rankingSchool/university historyRatio of home to international studentLevel of engagement in extracurricular activities
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