Parental Consent Form

Guardian Consent Form
This form must be completed by the parent/guardian of any student under the age of 18 attending a course at Atlantic Language.

Student Details

Mr. Jacob

Parent / Guardian Details (Complete in Full)

Mr. John
Gender *
ie. Father / Mother

Please answer all of the following questions

AG245691 [Please put N/A if you do not have a European Health Card]

EHIC (European Health Insurance Card) issued by (name of organisation) and Expiry Date

[Please put N/A if you do not have a European Health Card]
[Please put N/A if you do not have a European Health Card]

Conditions of Acceptance

  1. Attendance at class, schedule activities, and excursions is compulsory.
  2. Students with special dietary or medical considerations are accepted solely at the discretion of Atlantic Language. Students with enuresis cannot be accepted.
  3. The use of alcohol, drugs or other proscribed substances is strictly forbidden. Students found in possession of alcohol, drugs or other proscribed substances will be sent home immediately at parents’/guardians’ expense. Parents/guardians will be advised of the termination of the student’s stay and must make arrangements for the student’s immediate return home. No refund of fees will be permitted in this circumstance.
  4. Under the provisions of Irish law, young people under the age of 18 years of age may not visit public houses (pubs) and they may not purchase alcohol.
  5. A student is responsible for any damage or injury he/she may cause to buildings, furniture, fittings, individuals’ or host family property, etc., while registered with Atlantic Language. The student and his/her parents/guardians will be responsible for the repair, replacement or reimbursement of any damaged property
  6. Where theft of property from the school, host family, another student or any other location, occurs the matter will be referred to the Irish police service, An Garda Síochána, who will investigate the matter and deal with it according to Irish legal procedures.
  7. A serious misdemeanour or infringement of the laws of Ireland will result in instant dismissal from the school. Costs incurred by the student as a result of dismissal from the school are the sole responsibility of the student and his/her parents/guardians. Atlantic Language will accept no liability of any kind.
  8. All students are subject to a curfew: they must be at their nominated host family or school residence by 22:30 each night.


Do you give permission to your child to exit the campus / accommodation unaccompanied during his/her free time as long as he/she returns to the campus / accommodation by the specified curfew time of 22:30? *
Do you give us permission to take pictures of him/her to support his/her testimonials, and to use his/her comments and photos for promoting or advertising purposes? *
I have read and understood the conditions of acceptance, and have explained the school rules to my child. *