Section One ~ ABOUT YOU

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					                                                                                                      ENROLMENT FORM

Section One ~ ABOUT YOU

Name as shown on passport: First Name:                       Other names:                    Family Name:
Male / Female:              Nationality:                  Age:                   Date of Birth:
Permanent Home Address:
City:        Postcode:                Country:
Telephone Number (+ ISD code):                      Fax Number (+ ISD code):
Email Address:
Current Address in UK/ Ireland (if applicable):
City:        Postcode:             Telephone Number (+ ISD code):
Where did you hear about Foyle Language School: Please select an option                              Details:
Current Level of English: Please Select
Any Examinations taken in English (enter grade/ score if applicable):
Section Two ~ YOUR COURSE

Course Name and Code: Please Select
For Cambridge Courses indicate level: Please Select
For IELTS Course please indicate CURRENT LEVEL: Please Select
Course Start Date:                    Duration:          weeks
Any notes/ additional Information:
Section Three ~ ACCOMMODATION

Do you need Foyle Language School to arrange accommodation for you?                                 YES              NO            (Mark with “X”)

Type of Accommodation Preferred: Please Select
Duration:          weeks             days          Start Date:                   End Date:
Do you smoke:               Any Allergies:            (continue on additional sheet if necessary)

Host Family Accommodation:                 What type of family would you prefer               (indicate preferences with “X” or YES/ NO)

Young/ Middle Age:             Retired:            Children:             Pets:
Any other additional information:
Section Four ~ AIRPORT TRANSFERS

Which service do you require: Please Select
Arrival Airport:           Date:           Time:           Flight Number:
Departure Airport:            Date:           Time:              Flight Number:
If you are arriving by any other form of transport, please give details:


Please continue to next page…..
                                                                                                   ENROLMENT FORM

Section Five ~ PAYMENT DETAILS

Bank Transfer
Please make all bank transfers payable to:
Account Name: Foyle Language School
Account No:         25677151
Sort Code:          93-84-83
Bank Address:       First Trust Bank
                    Meadowbank Branch, Derry, BT48 7TN, Northern Ireland
I have sent my booking deposit: Yes                    No
Method of Payment                        Bank Transfer                Cheque
Section Six ~ AGREEMENT AND SIGNATURE

    1.   I have read and agree to the TERMS AND CONDITIONS OF ENTRANCE outlined by Foyle Language School
    2.   I have read and understood the relevant schedule of costs set out in the price list and hereby confirm that I have sufficient funds to
         pay for all tuition costs including all personal costs (food, accommodation) during the period of my course.
    3.   I authorise Foyle Language School to take appropriate action in the event of a medical emergency and I understand that I am
         responsible for all insurance provisions and medical and dental bills that may be incurred during my stay.
    4.   I certify that all information given by me is accurate and complete


    Please insert name (or signature if possible):
    Date:


                                          Please return this form via email to:


                                            mura@foylelanguageschool.com

				
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posted:10/4/2012
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