Part 1 of 7 - Personal Details
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| First Name*
Last
Name*
*
Must be completed |
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| Sex *
Male
Female |
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| Add 1*
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| Add 2 |
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| Add 3 |
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| Tel
E-Mail*
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| First Language Date
of Birth |
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| Current Level of English |
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Have you previously attended a
course at Bray Language Centre
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Part 2 of 7 - Family Details
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| Parents' / Guardians' Names
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| Add 1 |
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| Add 2 |
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| Add 3 |
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| Tel
Summer Tel No |
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| Summer Address |
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Part 3 of 7 - Course Details
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| Course Chosen (Date)*
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| Course Description |
College Course |
Four to One Course |
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Details of special dietary and
/ or other requirement
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Part 4 of 7 - Arrival Departure Details
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Date
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Time |
Flight No |
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| Arrival |
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| Depart |
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| Do you require an airport transfer ? |
Arrival |
Departure |
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Yes No
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Yes No
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| Airport Transfer Prices |
To be advised.
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Part 5 of 7 - Parents' / Guardian Consent
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| 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
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Part 6 of 7 - Rules
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| I the undersigned declare to
have read, understood and accepted all the Student |
Parent/Guardian * |
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| Rules of Bray Language Centre |
Student *
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| Copy of Rules -
click
here |
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Part 7 of 7 - Payment Details (bank details will be
e-mailed to you)
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| Full Fee or Deposit * |
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| Full Fee
, or |
Deposit of E 200 |
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| I will be paying by |
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| Bank Transfer
| Eurocheque
| Cash |
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| Bank Details will
be e-mailed to you. |
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