Individual Application Form

Name of Pupil(Required)

Pupil date of birth(Required)

Age(Required)

Form (at current school/college)(Required)

Email address(Required)

Reason for stay(Required)

Dates(Required)

Number of nights(Required)

Course(Required)

If other, please specify(Required)

Name & contact details of your school nurse(Required)

We will contact the school nurse to obtain your medical record

Dietary requirements(Required)

If yes, please list these and the medication taken(Required)

Declaration please sign(Required)

Upon signing, you give your consent for your child/ward to stay at the Lions centre for the above period, under the guidance of St. George’s Guardians (https://stg-guardians.co.uk/). Therefore this forms a contract of agreement with the Lions centre.

Parent email address(Required)

Guardian email address(Required)

CAPTCHA