Guardianship Service Request Form – Student Information

Guardianship Service Request Form – Student Information

    Student Details

    Surname*:

    First Name*:

    Middle Name:

    Preferred Name:

    Date of Birth*:

    Gender*:

    City & Country of Birth*:

    Nationality*:

    Religion:

     

    Native/First Language Spoken*:

    Additional Language Spoken:

    Level of English*:

    Contact Number*:

    Email*:

     

    Passport Detail:

    Passport Number*:

    Issuing Country*:

    Date of Issued:

    Passport Expiry Date*:

    Is a visa required for the student to enter the country*?

    If yes, has the visa been grated?

    Visa Expiry Date:

     

    Education Details

    School Name*:

    Telephone Number*:

    Full Address (inc postcode)*:

    Expected Start Date*:

     

    Year:

    Course:

    Does student have any learning difficulties or disabilities? *

    Please Specify

    If yes, would you like Redoor Guardianship Ltd to arrange educational support outside of school hours?

     

    Parents Detail:

    Father Full Name*:

    Father Occupation*:

    Permanent Address (Country of Residence)*

    Home telephone:

    Mobile*:

    Can confidential information be emailed to your address?*

    Email:

     

    Mother Full Name*:

    Mother Occupation*:

    Permanent Address (Country of Residence)*

    Home telephone:

    Mobile:

    Can confidential information be emailed to your address?*

    Email:

     

    Alternative Contact (in case of emergency)

    Name*:

    Relationship*:

    Contact Detail

     

    Student Health and Medical Details

    Does student suffer from health Problems? e.g. allergies, asthma, etc?*

    If yes, please specify:

    Does student suffer from any mental health issues? e.g. psychiatric or emotional problems?*

    If yes, please specify:

    Is student taking any prescribed medication(s)?*

    If yes, please specify:

    Do you require use to arrange for repeat prescriptions?*

    If yes, please specify:

    Does student have any special dietary requirements?*

    If yes, please specify:

    Does the student have insurance? e.g medical and dental?*

    If yes, please specify the type of insurance:

    Does the student suffer from any chronic illness?*

    If yes, please specify:

    Does Redoor Guardianship have consent to make emergency medical and dental decisions for students?*

    For minor ailments, is there consent to the administration of over the counter medication? e.g. paracetamol or cough syrup.*

    Is student allergic to any medication?*

    If yes, please specify:

     

    Pastoral Care

    Does the student like domestic animals?*

    Are there any animals the student does not like or is allergic to?*

    If yes, please specify:

    Does the student smoke?*

    Is the student allergic to any food?*

    If yes, please specify:

    Has the student live/been away from home prior to this?*

    If yes, were there any issues when the student was living/away from home?

    If yes, please specify:

    Student’s favourite sport(s):

    Student’s favourite hobbies:

    If application, please provide any special requests the student may have in regards to a host family.

     

    Travel and Leisure

    Is student permitted to travel independently?*

    Is student permitted to go on school trips organised by the school, under adult supervision?

    Please list any special activities that student NOT allowed to participate in

    Is student permitted to stay with relatives/family members in the UK?*

    If yes, please provide their full name, address and telephone number. Please note, this can be updated via email as required.

    Is the student permitted to stay at their friend(s)?*

    If yes, please provide their full name, address and telephone number. Please note, this can be updated via email as required.

     

    Declaration and Signature

    I/WE have read and understand the terms and conditions* as set by Redoor Guardianship Ltd and accept Redoor Guardianship Ltd to act as guardians for the Student.

    Father

    Signature

    Name in Full:

    Date:

    Mother

    Signature

    Name in Full:

    Date:

    If Neither the student’s father or mother has signed the application, a legal guardian/representative may sign. A reason must be provided.

    Signature of guardian/legal representative (if applicable) Reason student’s father or mother is unbale to sign document.

     

    I/We, at Redoor Guardianship Ltd, accept to be education guardian(s) for the aforementioned student and will adhere to with the terms and conditions set out within the parent and guardianship organization agreement.

    Signature

    Name in Full:

    Position:

    Date:

     

    Terms and conditions are in the parent and guardianship organization agreement. Redoor Guardianship Ltd will start guardianship responsibilities upon the student’s arrival in the UK and after full payment has been received.