The ELS Application Form

2017 July COURSE

 

Thank you for applying to the QBE European Leadership School. If your application is accepted you will need to make a £300 (approximately US$500 deposit) to hold his/her place. You also will need to fill out a Medical Insurance form, a Medical History form, and an Indemnification form as part of a Contract (which will be emailed to you). 

Name of Applicant *
Name of Applicant
Include any nickname in the first field.
Address *
Address
Gender *
Date of Birth *
Date of Birth
If you can, please tell us what plans you have for your future.
If there is any additional information that would be useful for us to know, please provide the details below (i.e., dietary restrictions, personality traits, medical issues, disabilities, etc.)
Name of Applying Parent or Guardian *
Name of Applying Parent or Guardian
Note that many countries require the permission of both parents for a minor child to travel abroad. Please obtain all necessary permissions and forward a copy to us.
Parent or Guardian's Address *
Parent or Guardian's Address
Please include their phone and email coordinates as well as their relationship to the applicant.
Fees
Fees
If different from Parent or Guardian, the name of the person responsible for tuition.
Address
Address
(We/I) confirm that, to the best our our/my knowledge,. the information provided is complete and accurate. We/I also understand that sailing and hiking involve certain risks and that, accordingly, we/I will be willing to sign an indemnity as part of a contract.