SUMMER SCHOOL APPLICATION FORM NAME & SURNAME: __________________________________________ D.O.B: __________________ ADDRESS: __________________________________________________________________________ FATHER/MOTHER’S NAME:______________________________________ ID No._________________ TEL/MOB: _____________________________ EMAIL ADDRESS:_______________________________ PAYMENT INFORMATION (required by Inland Revenue Department in case of those who pay tax in Malta and so are entitled to a tax rebate of up to €2000) NAME & SURNAME (of person in whose name the rebate form is to be issued) __________________________________ ADDRESS: __________________________________________________________________________ ID/Tax No._________________ TEL: _______________ EMAIL ADDRESS:_______________________ SUMMER SCHOOL PROGRAMME: 5-DAY (Mon – Fri) 3-DAY (Mon, Wed & Fri) FULL PROGRAMME: €460 HALF PROGRAMME: €280 8th July – 2nd Sep 8th July – 29th July 30th July – 2nd Sep FULL PROGRAMME: €360 HALF PROGRAMME: €230 8th July –2nd Sep 8th July – 29th July 30th July – 2nd Sep 2-DAY (Tue & Thur) FULL PROGRAMME: €260 8th July – 2nd Sep HALF PROGRAMME: €180 8th July – 29th July 30th July – 2nd Sep Kindly make cheques payable to: CHISWICK HOUSE SCHOOL TRANSPORT: EXTRA HOUR: Yes Yes No No If yes, kindly fill in Transport Form included with this pack. If yes, kindly fill in Extra Hour Form included with this pack. DID YOUR CHILD ATTEND CHS DURING THE SCHOLASTIC YEAR 2014 – 2015? If NO, kindly fill in Getting to Know You Form. __________________________ Parent’s Signature _________________________ Date Chiswick House School may from time to time take photos of the children during Summer School in order to use them for promotional purposes. As required by the Data Protection Act, should you NOT wish to have your child/ren appearing in such photos kindly tick this box. Application forms will be accepted on a first come first served basis. Please fill in one application per child. Receipt _______ Cash/Cheque no _______ Amount _______ Receipt no _______ Signature _______ Date