Family name First
name
Date
of Birth Sex
Nationality
Occupation
Address
Passport
Number
Telephone
no Fax
no
E-mail
address 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
Please
select General
English Intensive
General English for Adults Cambridge
Exam Course General
English Plus 8 X 1:1 General
English Plus 4 X 1:1 General
English Plus 8 X business 1:1 General
English Plus 4 X business 1:1 Summer
Course (Junior/teenager) Executve
Intensive
Please
select Beginner Elementary Pre-Intermediate Intermediate Upper-Intermediate Advanced
Total
Number of weeks
Start
date
(normally a Monday)
End
date (normally
a Friday)
Other
course requirements
Accommodation
Type
of Accommodation
Please select
NO ACCOMMODATION NEEDED
HOST FAMILY SINGLE ROOM
HOST FAMILY SHARED ROOM
HOST FAMILY EXECUTIVE
HOSTEL ACCOMMODATION
HOTEL / B+B
Start
Date (Check-in) End
Date (Check out)
Other
accommodation requests or details of allergies/illnesses:
Travel Details (if known)
Arrival
Date
Arrival
Time Departure
Date Departure
Time
Airport/port/station Flight
Number
Airport/station (Departure)
Flight
Number
Would
you like us to book a transfer by National Express coach? (cost
will be about £40 + £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 £180
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
select I will pay by credit card on the
payments page
I will pay by bank transfer
I will contact the school
to discuss payment
