Inscription EIC Summer Camp 2015Family Information

Tutor 1 (Name and surnames)

Tutor 2 (Name and surnames)

Address;

TownPost Code

email address

Telephone numbers in case of having to contact childrens family written in order according to necessity.

Ord.NameRelation to pupilTelephoneObservations

1

2

3

Information Pupil 1

Name:Surname 1Surname 2

Date of birth:Course attended in 14/15 school year

School attended 13/14Is pupil registered for EIC 15/16 school year?Yes NO

Care service?( 8h-9h 10/Week)Yes NOIs pupil staying for lunch?Parents who collect children before lunch at 13:00 25/week will be discounted. This request must be made on inscription and will not be valid after.YES NO

Weeks29 June-3 July 6 10 July1317 July 2024 July 2731 July

July activity: Camp School Timetable: 9-13 9-15 9-17

SeptemberCamp School

Information Pupil 2

Name:Surname 1Surname 2

Date of birth:Course attended in 14/15

School attended 13/14Is pupil registered for EIC 15/16 school year?Yes NO

Care service?( 8h-9h 10/Week)Yes NOIs pupil staying for lunch?Parents who collect children before lunch at 13:00 25/week will be discounted. This request must be made on inscription and will not be valid after.Yes NO

Weeks29 June-3 July 6 10 July1317 July 2024 July 2731 July

July activity: Camp School Timetable: 9-13 9-15 9-17

SeptemberCamp School

Information Pupil 3

Name:Surname 1Surname 2

Date of birth:Course attended in 14/15

School attended 13/14Is pupil registered for EIC 15/16 school year?Yes NO

Care service?( 8h-9h 10/week)Yes NOIs pupil staying for lunch?Parents who collect children before lunch at 13:00 25/week will be discounted. This request must be made on inscription and will not be valid after.Yes NO

Weeks29 June-3 July 6 10 July1317 July 2024 July 2731 July

July Activity Camp School Timetable: 9-13 9-15 9-17

SeptemberCamp School

Important: Documentation to be attached; Photocopy of NIC of authorised tutor. Photocopy of Medical Card Photo of participating child.

Tutor Authorization (One per participant)Mr./Mrs._________________________________________(Full ame) Identity n__________________As ____________________ (relation to participant) hereby authorize________________________ (name of participant)to attend the activities organized by ESCOLA INTERNACIONAL DEL CAMP within the programmes of EIC SUMMER CAMP which will take place from 29th July to 10th September of the current year and certify with my signature the authenticity of all data which is written on this document, also extending with this authorization for the specifics that are detailed herein including travel, medical, image and data protection. s).With the completion of this form I hereby authorize specifically that the data contained on this form as well as all documentation included may be dealt with and incorporated in a file which is the responsibility of Foundation Escola Internacional del Camp, CIF G-43731256 also Lescola Internacional del Camp with registration number CIF B555433831 confirms that which is included in articles 15 and 16 of the Law llei Organica 15/1999 of 13 de December of Personal data protection . Please be informed that you can exercise your right of access , rectification , cancellation or opposition to the school at Salvador Espriu s/n, 43840 Salou (Tarragona)Medical Information

Does the child suffer from any chronic illness?Could it affect their daily activities

Does the child need to take any medication?Times and Dose of medication with doctors prescription

Any food intolerance?Any dietary recommendation?

Other remarks especially allergies.

Other Information

Can your child swim ?Yes NO

Authorization

I hereby authorize that my child can carry out excursions, trips programmed in the activity programme as well as any journeys in a school car that may be required for the child or doctor etc..YES NO

I authorize that the data and protocol of my parental responsibility will be accessibleYes NO

I authorize that medical decisions that should be required to be taken in case of extreme emergency be taken by the faculty management.YES NO

Authorize that EIC, ESCOLA INTERNACIONAL DEL CAMP may use graphic material such as photos or videos coming from activities carried out by my child during the various PROGRAMMES EIC SUMMER DE 2015Yes NO

Salou, _________Date__________________________ 2015

Signature Parent of Guardian.ESCOLA INTERNACIONAL DEL CAMP-SALOU- Carrer Salvador Espriu, s/n 43840 SalouApartat de correus 263 Telfon 977 325 620 serveis@escolainternacional.org