Bray Language College
Registration Form

Part 1 of 7 - Personal Details
First Name 
*Last Name *
Gender   
 Male      Female *
Address Line 1*
Address Line 2
Address Line 3
Tel  
E-Mail Address *  
First Language*
Date of Birth
Current Level of English
Have you previously attended a course at Bray Language Centre
   
Part 2 of 7 - Family Details
Parents / Guardians Names
Add 1
Add 2
Add 3
Tel 
Summer Tel No
Summer Address
   
Part 3 of 7 - Course Details
Course Chosen (Date)*
Course Description 
 College Course  Four to One Course
 
Details of special dietary and / or other requirement  
   
Part 4 of 7 - Arrival Departure Details
  Date Time Flight No
Arrival
   
Departure
   
Do you require an airport transfer ?
  Arrival Departure
  Yes No  Yes  No 
   
     
Part 5 of 7 - Parents / Guardians Consent
Minors [ those under 18 years of age ] are not permitted to go out in the evenings unless accompanied by a group leader or a responsible member of the host family. The authorisation to go out in the evening unaccompanied must be signed by a parent / guardian in the space provided below. In any event, the student must give his / her word to re-enter the host family home no later than 11:00 p.m. Bray Language Centre do not accept any responsibility in respect of the student’s failure to re-enter the family home at the prescribed time.

 

Guardian / Parent * Please tick to indicate consent
     
Part 6 of 7 - Rules    
     
I the undersigned declare to have read, understood and accepted all the Student Rules of Bray Language Centre
Parent/Guardian *
Student              *
     
Copy of Rules - click here    
     
Part 7 of 7 - Payment Details (bank details will be e-mailed to you)
     
Full Fee or Deposit  *
      
  Full Fee , or Deposit of Euro 200
     
I will be paying by:
    
  Bank Transfer   | Eurocheque   | Cash
     
Bank Details will be e-mailed to you.  
     
Thank You.    

Please enter all fields marked with *

Updated 10/4/2008