Application Form

International Summer sports Camp Application Form (August 2022)

Family Name *

Given Name

Gender

Male
Female

Tellephone *

Home Country Address: *

Email *

Does this student require any behavioral or special care? If yes, what type of care?

Is the student undergoing any medical treatments? If yes, please specify?

Does the student wish to join the General Swahili class?

Yes
No

Full name of accompanying guardian (for students) *

Full Name *

First

Middle

Last

Given Name *

First

Middle

Last

Country Of Residence

Address

Telephone Number (Home)

Telephone Number (Mobile)

Have you attached a copy of the Travel & Medical Insurance Policy?

Yes
No

I, (Parent/Guardian Name: Acknowledge that I am aware that it is mandatory for my child to hold a travel/ medical insurance policy in order to join at Fountain Gate Sports summer camp program. *

First

Middle

Last

Full Name *

First

Middle

Last

Am

Father
Mother
Guardian