Your Information

YOUR Name (required)
LAST / FAMILY Name (required)
Date of Birth (dd/mm/yy) (required)
Gender:
COUNTRY of Origin/Birth
PASSPORT Number (required)
HOME ADDRESS (required)
PHONE (incl. country & area codes)
Your EMAIL (required)

Emergency Contact Person

CONTACT FULL NAME (required)
CONTACT PHONE Number (required) (incl. country & area codes)
RELATION TO YOU
CONTACT E-MAIL (required)

English Programme

SCHOOL NAME
START DATE (mm/yy)
END DATE (mm/yy)
LOCATION / ADDRESS
LEVEL OF ENGLISH:

Homestay Information

START DATE (mm/yy)
END DATE (mm/yy)
Do you have special dietary requirements?
If yes, please indicate below. (For example, are you a vegetarian?)
Do you have any allergies? If yes, please indicate them:
Do you take any medications. If yes, please indicate them:
Please list your Hobbies/Interests:
Can you live with pets?
Do you smoke?
Can you live with young children?

Airport Transfers

ARRIVAL DATE AND TIME
FLIGHT #
Do you need airport pickup?

Payment & Other Information

How will you pay?

Enrolment conditions and refund policy

I have read and agree to be bound by the Terms & Conditions and the Payment and Refund Policy (select the checkbox if you agree)
My payment deposit will be made at least four weeks prior to the school start date (select the checkbox if you agree)
How did you hear about us? (e.g., search engine--please specify; friend, agent):
Please enter the following code: captcha

This 'code' is to validate that you are a person & not an Internet spambot.

Your application will be reviewed and processed once received.
At this point we will send you an invoice with our simple payment procedures.