Enrolment Form

Personal Details
Family Name
Given Names
Date of Birth
Gender	Male Female
Age at start of course
Nationality
First Language
Home Address
Country
Telephone
Mobile
Email
Verify Email address
What is your language Level?
(Please note we do not take beginners on most courses. Please contact the school)
Have you ever taken a language exam (e.g. FCE, CAE, IELTS,TOEFL) ? Yes No
What exam was it?
What result did you get?
Have you studied at a GEOS school before? Yes No
If so where?
If so when?
Where did you hear about GEOS?
Course Details
Name of Course
When does your course start?
When does your course end?
Emergency Contact Person (to be contacted if you are very ill or have an accident)
Name of Person
Who is this person (e.g. mother) ?
Telephone (day)
Telephone (evening)
Mobile
Accommodation
Would you like us to arrange accommodation for you? Yes No
Number of weeks
Accommodation Start Date
Accommodation End date
If No, where will you live?
If No, would you like us to send hotel and hostel info to you? Yes No
Accomodation: Homestay
Half Board, Single Half Board, Shared Bed and Breakfast, Single Bed and Breakfast, Shared
Do you smoke?	Yes No
Is it OK if the family smokes?	Yes No
Any other requests (e.g. no dogs, no cats, I like children)?
Accomodation: Residential
Young Learners Holiday only - full board. Yes No
Health
Are there any foods you cannot eat? Please select. Red Meat White Meat Pork Fish Dairy Other
Do you have any health problems, (e.g. allergies, diabetes)? Yes No
Please give details
Are you on any medication? Yes No
Please give details
GEOS strongly recommends that you take out full travel and health insurance for your time with us, would like information on insurance offered by GEOS? Yes No
Airport Transfer
Would you like Airport Pickup?	One Way Return No
Which airport will you arrive at?
Flight No and arrival time

Enrolment Form

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