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Parent/Guardian (completer of the form unless child is over the age of 18)

First Name

Last Name

Phone Number

Placement Name

Placement

Student Details

First Name

Last Name

Known as

Phone Number

Date of Birth

School Name (In Full)

School Year (e.g. Yr 13)

Billing Details

First Name

Last Name

House / Street

Town / City

County

Postcode

Country

I (parent/guardian) understand that my child/dependent is committed to undertaking a tutored work placement with Operation Wallacea. They will be expected to respond in a timely manner to all correspondence relating to this placement, will follow all reasonable instructions relating to the tasks involved and will be available to begin the placement on the date selected above. We are entering into this agreement in good faith and will commit to ensuring that the placement is completed successfully.I agree to the above terms and conditions.

Wallace House, Old Bolingbroke, Spilsby, Lincolnshire PE23 4EX, UK

| +44 (0) 1790 763194 | info@opwall.com

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