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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
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Ref N° that you will
need to quote on all correspondence, e-mails or when contacting us
by telephone.
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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
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First Name* |
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Last Name* |
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D.o.B.* |
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Age:* |
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Gender:* |
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Home Tel N°
(country
code first) |
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Work Tel N° (country
code first) |
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Mobile Tel N° (country
code first) |
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Fax N°
(country
code first) |
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E-mail |
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Address:* |
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Next of kin Address: (if different from above) |
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Next of kin Tel No:
(country
code first) |
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You work for: |
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Your position is: |
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You have worked for this company for: Months/Years
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The most important situations where you have to speak English are:*
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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:* |
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You have a degree/diploma/certificate in:
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What is your mother tongue?* |
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Nationality:* |
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Do you: Smoke?*
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Date course starts:* |
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Date course ends:* |
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Time of arrival: |
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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:* |
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Type of accommodation: (please tick) |
Host family: Hostel: Hotel: |
With packed lunch: |
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Date of arrival: |
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Date of departure: |
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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: |
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Airport of Departure: |
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Airport of Arrival: |
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Other useful
information: (allergies, particular diet etc) |
How did you find our website?*
Please quote Ref N° if applicable:
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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:
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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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