* Required

Dwight School London Arts Educational Trip to Buenos Aires, Argentina, South America Summer July 2019 (exact dates tbc).

I confirm that I would like to register my child to attend the Dwight School London Arts Educational Trip to Buenos Aires, Argentina, South America summer July 2019*

Yes No

Upload a copy of your son/daughter’s main passport page hererequired

Max file size: 10 MB

I confirm that my son’s/daughter’s passport*

does expire before 1st January 2020 does not expire before 1st January 2020

Student first namerequired

Student surnamerequired

Date of Birthrequired (dd/mm/yyyy)

Passport numberrequired

Date of passport expiryrequired (dd/mm/yyyy)

Nationality of passportrequired

Visa number

Special dietary requirements*

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Please give detailsrequired

Allergies*

Yes No

Please give detailsrequired

Emergency contact namerequired

emergency contact numberrequired

Medical condition*

Yes No

Please give detailsrequired

medication required*

Yes No

Please give detailsrequired

Name of Doctor in the UKrequired

I give permission for a staff member to give my son/daughter paracetamol, ibuprofen or an aspirin based product*

Yes No

In Loco Parentis*

I hereby give permission for Dwight School London staff to give authority on my behalf for any medical treatment recommended by competent medical authorities, where, in the doctor’s opinion, it would be contrary to my son/daughter’s interest for any delay to be incurred by seeking my consent.

Yes No

By submitting this form I am fully aware of the terms and conditions of the school trip and I am aware that we can request infomation about the school trip insurance from the school office*

Yes No

I understand that I will apply for my son/daughter’s visa through the Argentinian embassy and I will attend appropriate meetings at Dwight School London *

Yes No

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

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