Application Form - Les Roches International School Of Hotel Management (Page 3 of 4) in pdf

Application Form - Les Roches International School Of Hotel Management Page 3

T O B E F I L L E D I N B Y T H E A P P L I C A N T

Please send this application

form to:

N a m e

The Admissions Department

Les Roches

International School

Date of Birth : Day

Month

Year

of Hotel Management

Rue du Lac 118 - 4

floor

S e x :

M a l e

F e m a l e

CH-1815 Clarens - Switzerland

Phone:

+41 (0)21 989 26 44

Name of Parent / Guardian

Fax:

+41 (0)21 989 26 45

E-mail:

admissions@les-roches.ch

Mailing Address

Website:

City

Postal Code

Country

Home Phone

Mobile Phone

F a x

E-mail

P E R S O N A L H I S T O R Y

Have you ever had or do you suffer from :

No Yes (if yes, when)

No Yes (if yes, when) )

No Yes (if yes, when)

Chicken Pox

Diabetes

Epilepsy

Rubella

Tuberculosis

Psychological Disorder

Measles

Hepatitis A/B/C

Sleeping Disorder

Mumps

please specify

Eating Disorder

For the following points, please specify if you:

Have any other disease or have had an operation recently

Have dyslexia or other learning problems (indicate to what degree)

Have allergies to any medicine or other products

Take any medication on a regular basis

Are on a special diet

Have had any accident with long-term consequences

With regards to any of the above special needs or medical condition you may have, Les Roches aims to create an environment which enables all

students to participate fully in the campus life. To help us make reasonable adjustments, it is necessary to clearly indicate your special needs

(ie. dyslexia) or medical condition. Please note that consideration of how we can meet any special needs is separate to the assessment of your

academic suitability.

How would you describe your general health condition?

Excellent

Very good

Good

Poor

In keeping with the school policies regarding preventive health measures, the School Director may request a student to undergo a medical

checkup at any time during his/her studies at Les Roches.

I hereby certify that the above information is correct and that I agree to undergo a medical checkup if required. Deliberate false statements may result in

expulsion. Les Roches will not be held responsible in case of incorrect medical information stipulated on the Medical Certificate and Physician’s Report.

Signature of the applicant

Date

Signature of the parent or legal guardian

Date

Registered office: GESTHOTEL SA – CH-3975 Bluche, Randogne