Application Form for language course and accommodation in Paris

Language Course Application Form

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SUMMARY

SECTION 1. PERSONAL DETAILS

Fill in the application form on-line. Please answer all

questions. All fields marked with an * are required and

must be completed

Once your application has been received you will be give a reference N° that you will need to quote on all correspondence, e-mails or when contacting us by telephone

We offer SSL on-line secure credit card

payment. For your convenience if you prefer, you can fax us

your application with your credit card details. We also accept

credit card payment over the phone, cheques and

bank transfers.

First Name*

Last Name*

D.o.B.*

Age:*

Gender:*

Nationality:*

Home Tel N° (country code first)

Work Tel N° (country code first)

Mobile Tel N° (country code first)

Fax N° (country code first)

E-mail

Address Line 1*

Address Line2

City*

County/State*

Zip/Postal Code*

Country*

Next of kin (if different from above) Address Line 1:

Next of kin Address Line 2:

Next of kin City:

Next of kin County/State:

Next of kin Zip/Postal Code:

Next of kin Country:

Next of kin Tel N° (country code first)

Present Employment:*

Name of work place:

Work Address Line 1:

Work Address Line 2:

Work Address City:

Work Address County/State:

Work Address Zip/Postal Code:

Work Address Country

Date of arrival:*

Date of departure:*

How do your rate your current level of the French?*

Type of course required*:

Extra services:

Choice of accommodation:*

SECTION 4. PAYMENT DETAILS

Pay to:

Totalnannies.com

Payment for:

Agency Fee for language

course and accommodation

abroad

Quantity:

Amount:

£99.00

ENTER YOUR CREDIT CARD INFORMATION

Your information will be kept secure and private

First Name*

Last Name*

Type of Credit Card*

Issue Number (only Switch Cards)

Expiration Date*

Billing Address Street*

Billing Address City*

Billing Address County/State*

Billing Address Postal Code/Zip*

Billing Address Country*

For your protection, we confirm credit card billing addresses.

The process normally takes about 30 seconds, but it may take

longer during certain times of the day. Please DO NOT cancel

your submit request until you have received a final response

from the server.

By clicking "Continue", I agree to be bound by

totalnannies.com's conditions

Conditions

1) The agency fee is equivalent to £99.00. It is inclusive of all expenses. The agency fee is due on application. 2) In the event of cancellation or failed arrival on the student’s part the agency fee in no circumstances will be refunded. 3) If we are unable to satisfy the student’s request the whole fee will be refunded. 4) The total tuition and accommodation fees are to be paid to the agency within 60 days before date of arrival. 5) In the event of cancellation within 14 days from the start of the course, tuition and accommodation fees will be refunded after having deducted £143.00. In the case of cancellation less than 14 days before the start of the course, tuition and accommodation fees will be refunded, after having deducted 1 week’s tuition and 1 week’s accommodation fees. In the event of cancellation after the course has already started no refund will be given. 6) No compensation will be given for days when the school is closed because of national or religious holidays. 7) The school does not accept responsibility for any loss or damage to students in any form. 8) Fees are calculated on the number of weeks of tuition from Monday to Friday and accommodation from Sunday to Saturday morning. A week started but not finished will be calculated as a whole week. I declare that I have read and accepted the conditions.

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