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Request for accommodation and language course in Dublin

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SECTION 1. PERSONAL DETAILS

 

INSTRUCTIONS

 

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Print out the application form, fill it in. Please answer all questions. All fields marked with a * are required and must be completed.

 

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Once your application has been received you will be given a

Ref N that you will need to quote on all correspondence, e-mails or when contacting us by telephone.

 

We accept cheques and bank transfers. For your convenience if you

prefer, you can send us your application form securely with our on-line credit card payment form

First Name*

Last Name*

D.o.B.*

Age:*

Gender:*

 

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:*

 

 

 

 

 

 

Next of kin Address: (if different from above)

 

 

 

Next of kin Tel No: (country code first)

 

You work for:

Your position is:

You have worked for this company for:           Months/Years

 

The most important situations where you have to speak English are:*

 

In this course you need a lot of practice in:* (please tick)

Comprehension:   Grammar:

Reading:    Speaking:  

Writing:

The last English language course you attended was:

Hobbies/Interests:*

 

You have a degree/diploma/certificate in:

 

What is your mother tongue?*

 

Nationality:*

 

Do you: Smoke?*

 

Date course starts:*

 

Date course ends:*

 

Time of arrival:

How long have you been studying English:?*

Level of spoken English:* (please tick)

Beginner:   Fair:   Good:  

Very Good:

Level of written English:* (please tick)

Beginner:   Fair:   Good:  

Very Good:

I would like to learn/improve my English for:* (please tick)

Pleasure:   Study:   Travel:   Work:

Type of course required:* (please tick)

A:   B:   C:   D:   R:   X:   Y:   Z: 

Special Courses:

If you wish to register for an exam please state it here:*

ACCOMMODATION

Do you require accommodation:*

 

Type of accommodation: (please tick)

Host family:   Hostel:   Hotel:

With packed lunch:

 

Date of arrival:

 

Date of departure:

 

Do you require transfer from the airport:? (please tick)

 Yes:   No:   One way:  

Both ways:

If airport transfer is required please let us have your arrival details here: (If you do not have this information yet please let us have it as soon as possible)

Flight N:

Airline:

Airport of Departure:

Airport of Arrival:

Other useful information: (allergies, particular diet etc)

How did you find our website?*  Please quote Ref N if applicable:

 

  SECTION 4. PAYMENT DETAILS

Pay to:

Totalnannies.com

Payment for:

Agency Fee for Language

Course and accommodation  abroad

Amount:

99.00

Payment for:

Booking Deposit (which will be deducted from the total cost of the course)

Amount:

80.00

Payment for:

Registration Fee

Amount:

38.00

Total amount:

217.00

I wish to pay this sum by: (please tick)

  Bank Transfer: Cheque: 

Conditions

1)The agency fee is 99.00 Sterling. It is inclusive of all expenses. The

fee must be paid on application and is not refundable.

2)The agency and the school cannot be held responsible for the loss of personal belongings and damage to people or property. Furthermore

the school cannot be held responsible for the impossibility to supply a service promised if this service could not be supplied because of

strikes or forces beyond the control of the school.

3)The total fees for the stay must be paid before departure or on the

first day of school.

4)No refund will be made for absences of a student during lessons or

for late arrivals. The fees are valid only for the dates stated on the application form. In the event of cancellation all fees will be refunded (excluding the deposit and the agency fee) as long as the agency was notified in writing at least 14 days prior to the commencement of the course. Once the course has started the fees will be refunded only in exceptional circumstances at the discretion of the directors of the school.

5)On application a non-refundable deposit of 80.00 is payable and a non-refundable registration fee of 38.00. The deposit will be deducted from the total amount due.

6)The school reserves the right, in the event of unruly behaviour to

expel a student from a course. In that case no refund will be made.
 

Signed:                                                                       Date:
 

 

 

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Germany

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Italy

 

 

 

Great Britain

France

 

Germany

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Italy

 

Spain

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USA

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Spain

Switzerland

 

USA

Japan

 

 

 

 

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