Academic Insights in India Enrolment Form

Section 1: Enrolment Information

Location(Required)

Age Range(Required)

Subjects of Interest

Academic Insights offers a combined subject curriculum so you will study a blended programme of academic subjects taught by a tutor from Oxford or Cambridge University

Programme Dates(Required)

Section 2: Participant Information

Participant Name(Required)

Participant First Name Participant Family Name

Participant Nationality(Required)

Date of Birth(Required)

Participant Preferred Pronouns(Required)

Participant Email(Required)

Participant Phone Number(Required)

Dietary Requirements

Does The Participant Have Any Medical Conditions?(Required)

Medical Information - Additional Notes

Section 3: Parent/ Guardian Details

Name(Required)

Your First Name Family Name

Parent/ Guardian Email Address

Does The Parent/Guardian Content To The Child Receiving Over-The-Counter Medicine (If Unwell)?

Medicines to be distributed if needed: Paracetamol (for pain relief and fever reduction), Ibuprofen (for pain relief and fever reduction), Piriton (to relieve symptoms of mild allergies, such as hay-fever), Strepsils (for sore throat relief), Simple Linctus (for mild coughs), Rennie (for heartburn and indigestion), Olbas Oil (decongestant for colds / congestion).

Other Information

Section 5: Emergency Contact Information

Emergency Contact Name

Emergency Contact First Name Emergency Contact Last Name

Emergency Contact Email

Emergency Contact Phone Number

Emergency Contact Phone (Alternative)

Confirmation

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Do you accept the booking terms and conditions?(Required)

Yes

India Academic Insights Booking Form 2022

Section 1: Enrolment Information

Section 2: Participant Information

Section 3: Parent/ Guardian Details

Section 5: Emergency Contact Information

Confirmation

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