IPSA - International Partners for Study Abroad

International Junior English Summer Camp in San Francisco.
Online Secure Application Form.

Part A. Personal data:


First Name of the Parent/Guardian:

Family Name of the Parent/Guardian:

First Name of the Student:

Family Name of the Student:

Home Address:

Street Address:



ZIP (Postal) Code:


Day Telephone Number:

Evening Telephone Number:


Fax: [optional]

Date of Birth of the Student: month day year            Male Female

Place of Birth (country, city):   

Citizenship (country):   

Passport Number:


Native language:

Other languages, if any:

Supplementary Information:

Does your child have any allergies? Yes.  No.

If yes, please list:

Does your child take any medication? Yes.  No.

If yes, please list:

Does your child have any allergies? Yes.  No.

If yes, please list:

Does your child require a special diet (i.e. Vegetarian)? Yes.  No.

If yes, please specify:

Has your child had any medical/psychological or social problems that might affect his/her ability to follow or complete the course satisfactory? Yes.  No.

If yes, please specify:

Please give details of any special requirements relating to health, allergies, diet, etc.:


Every student must have a comprehensive insurance package before leaving home. This should cover loss and/or damage to personal belongings, medical expenses in the event that the student is ill, and course fees in the event of an unexpected cancellation or curtailment of the student's course.

We accept no liability for the loss of, or damage to, any person's property while on the summer school premises, or while engaged in leisure activities outside the campus.

My child's insurance company is:

Policy Number:

Emergency Contact:





Part B. Program data.

I wish to book Weeks

I wish to start classes on (Day) (Month) (Year)

I wish to book Residential program (with accommodation)
I wish to book Day Camp program (without accommodation)

I wish to book a 3-week English for Future Coders Residential program
I wish to book a 3-week English for Future Coders Day program (without accommodations)

    add Tennis Instruction with 5 hours coaching per week
What is the student's present level of English?
    High Intermediate
For how long has your child studied English?

Please give details of any English courses and examinations your child has taken (date taken/grade achieved):

Visas, Permission to Travel, and other travel documents:

It is the responsibility of the student's parents/guardians to contact their local embassy (or other appropriate office) in good time in order to obtain any visas/entry documents required for visiting the USA. In cases where a visa is refused, please send us a copy of the visa refusal letter from the Embassy or Consulate. Our normal cancellation charges apply if notification of a failed visa application is received less than 40 days before the course begins. If the visa refusal letter is received more than 40 days before the course begins, a full refund will be given less a non-refundable application fee, tuition deposit and bank and payment processing charges, if any.

Please be aware of your country's requirements on the laws regarding unaccompanied children travelling abroad. A consent document or letter may have to be produced upon departure to prove that the child has the permission of the parents or guardian to travel.

To ensure that individual junior students travelling alone, and small groups of juniors travelling without a group leader, are not held up at US Immigration, we will issue a letter of confirmation to be shown upon arrival.

Travel to and from Junior summer Camp:

NB: all arrivals and departures are on Sundays

Return airport transfer is included in the package price for groups of 12 students or more. We can arrange airport transfers for individual students or small groups upon request.

Do you want us to arrange an airport transfer for your child? Yes.  No.

If you answered No to the last question, please give the name and contact details of the person collecting your child from the airport:




Please supply flight arrival and departure information:

Please note: you can send us the flight arrival and departure information at a later date after submitting this application.

Arrival Information:

Arrival Date: (Day) (Month) (Year)

Arrival Time: (24 hour clock)

Arrival Location: (airport)

Airline and flight number:

Departure city:

Departure Information:

Departure Date: (Day) (Month) (Year)

Departure Time: (24 hour clock)

Departure Location: (airport)

Airline and flight number:

Part C. Payment of Fees:

    A non-refundable application fee of US$100.00 and Tuition Deposit of $500 are required with your application. The Tuition Deposit is part of the cost of your course and is deducted from the total course fees. Please note that your application will be considered only when your payment of the application fee and the tuition deposit has been received.

    Upon receiving your application, the application fee and the deposit, we will send you a registration confirmation and invoice.

    The payment of the balance of fees is due upon receipt of invoice. Your child's place will be confirmed only when the full payment has been received. The full payment must be paid before we can issue documentation in support of a visa application.

    You may pay the balance by wire transfer, check or money order, or by credit card.

    Please note that you may apply online only if you pay the application fee and the tuition deposit by credit card.

    You can also print out a a printable application form in PDF from your browser, fill in your application and send it by post or by fax. If you use the printable application form, you can make your payment of the registration fee and deposits by credit card, check or international money order or by wire transfer to our bank account.

Payment by Credit Card

We accept VISA and MasterCard. In this Form, we utilize the Secure Socket Layer (SSL) authentication and RC4 128 bit encryption technology. SSL encryption protects information being transmitted across the internet to our processing center.

Please select payment option below:

Please charge the application fee of $100.00 and the tuition deposit of $500.00 to my credit card provided below.

Please charge the application fee and the full payment to my credit card provided below.

Even if you select a "full payment" option, we will charge the application fee and the deposits only at the time of accepting your application and will process the payment of the balance to your credit card after registering you for the course. Please also note that if you would prefer to pay the balance by credit card, a 4.5% convenience payment processing service fee will be included in the invoice. There are no any additional charges on your payment of the application fee and the tuition deposit by credit card.

To process your payment using Visa or MasterCard, please fill in the fields below with the requested information EXACTLY as it appears on your monthly bankcard statement.

Please select credit card:


Expiration Month:

Expiration Year:

Card Verification Value:
The last three digits on the back of your credit card after the credit card number. This value protects you from online fraud by verifying that you are in possession of the card you are attempting to use.

Cardholder Billing Information:

Cardholder Name:

Street Address:



Zip Code:

Please double-check the above credit card information.

Part D. Agreement and release.

By submitting this Application, I grant the student permission to participate in the full program of classes and leisure activities and authorize IPSA and program provider to take appropriate action in the event of any medical or other emergency and accept responsibility for the resultant costs. I also accept responsibility for any damage caused by the student and resultant cost for repair or replacement. I certify the above information is complete and correct. I understand that my misrepresentation may result in my child's expulsion from the program. I acknowledge that the terms and conditions appearing on Study Abroad International web site constitute part of my agreement with IPSA and study abroad program host (university, college, language school, or other institution and/or organization), including sections concerning responsibility, health, refunds, changes in dates, accommodations, courses and billing of the selected options; I assume all risks and responsibilities and discharge IPSA and the study abroad program host and all their officers, agents and employees from and against any and all claims of damage to personal property or personal injury which may result from my enrollment and participation in the study abroad program host courses, excursions, and/or on and off-campus activities. I have read the terms and conditions of enrollment and agree to follow all IPSA and study abroad host procedures. This Agreement will be effective when my application is accepted by IPSA and shall be governed by the laws of the State of Arizona, USA.

Yes, I agree. I don't agree

Please click on the button to submit the Application: