+ 34 96 328 3408
+ 34
96 320 7832
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: