Summer 2020 Participant Application FormSTUDENT'S FAMILY NAME*STUDENT'S GIVEN NAME(S)*ENGLISH NAME (if different)STUDENT'S GENDER*DATE OF BIRTH (DD/MM/YYYY)* Date Format: DD slash MM slash YYYY STUDENT PHOTO*Accepted file types: jpg, jpeg, gif, png.Accepted formats: jpg, jpeg, png or gifARRIVAL DATE* Date Format: DD slash MM slash YYYY DEPARTURE DATE* Date Format: DD slash MM slash YYYY EMERGENCY CONTACT NAME (and relationship with student)*EMERGENCY CONTACT TELEPHONE NUMBER (including country code)*CONTACT EMAIL ADDRESS* PARENT'S CONSENT FOR STUDENT TO TRAVEL INDEPENDENTLY FROM OVERSEAS (YES/NO or N/A)*YESNON/ATAUGHT IN ENGLISH (YES/NO or N/A)*YESNON/AIF NOT TAUGHT IN ENGLISH, ENGLISH LEVEL (IELTS OR EQUIVALENT IF KNOWN)PASSPORT NUMBER*PASSPORT VALID UNTIL (DD/MM/YYYY)* Date Format: DD slash MM slash YYYY NATIONALITY*VISA LETTER NEEDED (YES/NO or N/A)*YESNON/ATRAVEL or DROP-OFF ARRANGEMENTS (if known)SPECIALIST SUBJECT CHOICE (Choose one from the following)*Business and EconomicsMedicinePhilosophy and PsychologyLawScience, Technology, Engineering and Mathematics (STEM)*Please note that it will not be possible to change subject choice after arrival in Cambridge.SPECIAL REQUESTS (including friends who would like bedrooms next to each other)ALLERGIES/ MEDICAL CONDITIONS/SPECIAL LEARNING NEEDS/ DISABILITIES/ DIETARY OR RELIGIOUS REQUIREMENTSPOLO SHIRT Chest Size*S - 35-37" / 89-94cmM - 38-40" / 95-102cmL - 41-43" / 103-109cmXL - 44-46" / 110-117cmXXL - 47-49" / 118-124cmTwo Cambridge Dream polo shirts are included in the course feeSCHOOL NAME*SCHOOL ADDRESS* Street Address City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country IS YOUR SCHOOL IN A GROUP OF SCHOOLS (YES/NO)*YESNOIF YES, WHICH GROUP?*APPLICATION DATE* Date Format: DD slash MM slash YYYY PARENT'S SIGNATURE (an electronic signature is acceptable if the completed form is emailed)*REFUND POLICY (please refer to Terms and Conditions condition 6 - https://www.cambridgedream.com/terms-and-conditions.pdf)Cancellations up to and including 180 days prior to arrival = 20% of total cost (deposit) non refundable Cancellations between 179 and 60 days prior to arrival = 60% of total cost non refundable Cancellations 59 days or fewer prior to arrival = 100% of total cost non refundableINSURANCE (please refer to Terms and Conditions condition 1 - https://www.cambridgedream.com/terms-and-conditions.pdf)The Student is required to obtain travel and medical insurance (to include cancellation insurance) if coming from overseas.CONSENT FOR PHOTOS AND VIDEOSOccasionally, Cambridge Dream may take photographs and video footage to be posted on the website for marketing purposes. Students will not be identified by their full names or contact details. If a Student does not wish to be included or a Parent does not consent to their child's image being included, please let us know prior to arrival or tell the photographer.DATA PROTECTIONCambridge Dream is registered with the Information Commissioner's Office (ICO) and follows the Code of Practice issued by the ICO. Personal information will be processed fairly and lawfully and in line with the provisions set out in the Data Protection Act (DPA) 1998 and the General Data Protection Regulation (GDPR) 2018. This iframe contains the logic required to handle Ajax powered Gravity Forms.