Live Spanish

Avenida Ausias March 32, Pta. 4
46006 Valencia
España
+ 34 96 328 3408
+ 34 96 320 7832
Cell + 34 657 383 490
learnspanish@livespanish.com
http://www.livespanish.com

ENROLLMENT FORM

PERSONAL INFORMATION

Family name:  ____________________________First name:  ___________________________ Age_______________

Address________________________________________________________________________________________

Nationality___________________ Sex______________ Marital status__________

Telephone (with codes)__________________________ Fax _________________________

Cell ____________________ email __________________Occupation ________________________

Hobbies and interests _____________________________________________________________________________

Do you smoke?___________________ Special diet? _____________________

Allergies or special medication:  ____________________________________________________

How did you hear about Live Spanish? ______________________________________________

COURSE INFORMATION

What are the your main expectations of the course ?

___________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

How many hours per week do you wish to study ? 15 ____20 ____25 ____

Which program do you prefer ? ONE-ON-ONE ____ PARTNERS OPTION ____ 

My level is : Elementary____ Lower Intermediate____ Intermediate____ Upper Intermediate____ Advanced____

DATES OF STAY

(Sunday through Saturday). Please give 3 choices of dates, if possible, in order of preference :

1.  Arrival : _________________Departure : ____________________

2.  Arrival : _________________Departure : ____________________

3.  Arrival : _________________Departure : ____________________

I will require airport transfer on :

Arrival : _________________Departure : ____________________

DECLARATION

1. I agree to pay the 100 € registration fee with this application and the remaining fees either by bank transfer prior to my
arrival or in cash upon my arrival to Spain. 
2. Fees will be paid in euros. 
3. I understand that no money can be refunded for any reason. 
4. I accept the prices and conditions on this form. 
5. I affirm that I am not suffering from any infectious illnesses. 

Signature ________________________________________________________  Date: _____________________ 
                                                  Student 

Signature _________________________________________________________ Date:_____________________ 
                               Parent or guardian if student is a minor 

Additional comments, special needs: