Personal Details




- -

Address of Parent / Guardian









Parent / Guardian EMERGENCY Telephone Number

Course Dates

(Monday)   to (Friday)

Select Age and Center

12-14 years of age: Bournemouth Centre (from 27 Jul)
14-17 years of age: Bournemouth Centre (Jun-Aug)
11-14 years of age: Weymouth Centre (Jun-July)


LEVEL OF ENGLISH

Number of years learning English:

Name and Address of School






Health

Have you suffered from -







Do you suffer from allergies; if YES, specify:


Other medical conditions / treatment:

Authorisation for a Student to go out Alone in the Evening


permission not given

Yes No

Yes No

Authorisation to Ride a Bicycle

Yes No

Accommodation- British Host Family


Accommodation Dates (from Saturday to Saturday):
   to


Single Room Shared Room

Do you like animals? Yes No
Do you like children? Yes No
Do you smoke? Yes No
Are you a vegetarian? Yes No

Special Health or dietary requests:


Comments on student's character which may help to make the stay a success:

Travel

FREE COACH TRANSFERS (On Saturdays Only)
ARRIVALS - From Heathrow airport to Richard Organisation Only. For free transfer you must arrive at Heathrow Airport between 10:00 and 17:00 on a Saturday

Date: (Saturday) Arrival Time: Flight No: From: Terminal:
FREE COACH TRANSFERS (On Saturdays Only)
DEPARTURES - From Richard Organisation to Heathrow airport Only. For free transfer you must depart from Heathrow Airport between 12:00 and 18:00 on a Saturday

Date: (Saturday) Departure Time: Flight No: Terminal: Destination:
PAID TAXI TRANSFERS - Prices shown are single journeys

Arrivals
Heathrow - Bournemouth £105
Heathrow - Weymouth £140
Date: Arrival Time: Flight No: From: Terminal:

Departures - includes accompanied check-in
Bournemouth to Heathrow £115
Weymouth to Heathrow £160
Date: Departure Time: Flight No: Terminal: Destination:
Read: terms and conditions