Student Details

Parent/Guardian Details

Emergency Contact

Please provide an additional emergency contact for the student that is different from the parent/guardian details already given above.

Ideally this person would reside in the UK at the time of the course in case of an emergency.

Student Qualification Level

Subjects

Students can take up 3 subjects for each week of study. Please list the subjects you would like to revise during your time with us. Please take care when listing the course code; it is essential that this is correct so that we can ensure that appropriate tuition is provided. If your subject is not listed, please request it in the space provided.

Course Dates

You can book either 1, 2 or 3 weeks at a time.

Please indicate which week(s) you would like to book.

Payment Details

Upon receipt of your booking form an invoice will be send with the details of how to pay and the full payment amount required.

Accommodation

Please indicate whether you would like to book residential (full-board) or non-residential (including lunch).

Dietary Requirements

If the student has any specific dietary requirements, please describe them here. We cater to most dietary requirements.

Educational Needs

Please also give details of any educational needs, such as dyslexia, or any other information that may affect the student's learning.

Medical Conditions and Allergies

Please provide information about any medical conditions or allergies that may affect the student whilst on the course. This information is particularly important in case of an emergency.

Fitzwilliam Academics requires all students to participate in the scheduled activities and offsite trips advertised in the Fitzwilliam Academics brochure. All activities are undertaken at the participant’s own risk. Please tick the box to confirm that you give permission for your son/daughter to participate and that all relevant medical conditions have been disclosed above.

Fitzwilliam Academics will use your personal data to make your booking and contact you with further details on the programme. Further information on how we use your data can be found in our privacy policy and data protection policy. Please tick this box to confirm that you have read this information and accept these policies.

From time to time, Fitzwilliam Academics would like to send you offers and information you might be interested in. If you would like to receive this information, please tick this box.