Important: Use this form to make a booking - not to request information.
Please read terms and conditions and send this form if you are in agreement.

Registration Form

Personal Details

Family name First name
Date of Birth Sex
Male
Female
Nationality Occupation
Address Passport Number
Telephone no Fax no
E-mail address -Required - Enter carefully Mobile phone no
Emergency contact details (name, address, phone/fax/email of someone to contact in an emergency)
How did you hear about Riviera English School?
Tuition
Course Level of English
Total Number of weeks

Start date
(normally a Monday)

End date
(normally a Friday)

Other course requirements

Accommodation
Type of Accommodation
Start Date (Check-in) End Date (Check out)
   
Smoker Yes No
Other accommodation requests or details of allergies/illnesses:
Travel Details (if known)
Arrival Date
Arrival Time Departure Date
Departure Time
Airport/port/station
(Arrival)
Flight Number
(Arrival)

Airport/station
(Departure)

Flight Number
(Departure)
Would you like us to book a transfer by National Express coach? (cost will be about £60+ £5 booking fee for a return ticket from/to Heathrow - depending on booking date) Yes No
Would you like us to book a taxi transfer (cost will be about £200 one way from London Heathrow) Yes No
Other notes about your arrival (for example- arrving by car)
Payment

Minimum booking deposit £200 (£200 will be deducted from the final invoice)
Payment method

Please read terms and conditions before sending. Click "send" if you agree to these

 
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Riviera English School

Hagley House, 38-40 The Terrace, Torquay, Devon, TQ1 1BN, England

T +44 (0)1803 212132 F +44 (0)1803 212139 E info@riviera-english-school.com W www.riviera-english-school.com
© Riviera English School 2001 - 2013 All rights reserved
Riviera English School Limited is registered in England - Company No 4689439