BASS Application

First Name *

Last Name *

Address 1 *

Address 2 *

ZIP / Post Code *

Country *
AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahrainBahamasBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, the Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Email *

Phone *

Date of Birth *

Gender *
MaleFemale

Anticipated Arrival at BASS (if other than 19th July)

Anticipated Departure from BASS (if other than 1st August)

For European / UK students only - Please provide Family Doctor Details (Name and Address and your NHS Number)

Please describe any medical condition that the BASS staff should be aware of. This includes prescription drugs taken. You are encouraged to bring copies of all prescriptions and to keep any medications in the original box/bottle. Your entry to the UK with medications not accompanied by a prescription could become complicated: *

Please indicate any special dietary requirements (Gluten/Vegetarian/Vegan/Lactose) *

Primary contact in case of emergency (name, relationship & telephone (Day, Evening and Other)): *

Secondary contact in case of emergency (name, relationship & telephone (Day, Evening and Other)): *

Permission to use pictures of the student on our website or Newsletter: I understand that I may be photographed or videotaped during my participation in BASS and that such images may be used to promote or publicise BASS. Any such images will not be linked to personally identifiable information. *
ConsentDo Not Consent

CODE OF CONDUCT: I understand that the Rules and Guidelines of the Summer School must be observed and failure to meet these expectations can lead to a sanction being applied which could extend to being asked to leave the school. I further understand that any costs associated with this will be my/my parents responsibility. *
AgreedDo Not Agree

Round-Table Topics: A feature of BASS is being able to explore your faith and the role your faith will play in your life. Several times during BASS we have scheduled round-table discussions to give you an opportunity to discuss and explore current topics from a faith perspective. If you have any ideas topics or specific questions to be discussed during this time please submit them here:

During the afternoons at BASS our classes and activities are less faith-based and, in fact, many are taught by students themselves. If you have a skill, talent or understanding of a topic that you would like to share, please indicate that here. Past student-led classes have included: drawing, yoga, calculus, self-defence and dance.

An important element to BASS is the student involvement in worship. From playing instruments and singing to actually leading worship, if you are interested in participating in worship please indicate your interest here.

Anything else we should know about?

For European / UK only - Please note that in the event of illness or a student falling short of the expectations of the Summer School, we may require them to be collected from the venue. This could either be by their parent or carer or by a responsible adult nominated by the parent or carer.

If you are able to collect from Purley Chase, please enter your details, if you are nominating another responsible adult please enter their details (Name, Email, Mobile, Relationship to attendee):

I consent to storage of my data according to the Privacy Policy *

I agree