Richard Language College

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ENROLMENT FORM (Under 18 years)
'Integra' Summer Intensive & CLAS Courses
Richard Language College
43-45 Wimborne Road Bournemouth
BH3 7AB
England
Fax: +44 1202 555874

Personal Details - (CAPITAL LETTERS PLEASE)
Family Name:
First Name:
Sex:
Date of birth:
Nationality:
Address of Parents/Legal Guardian:
Tel: Home:
Business:
Emergency telephone number during time of stay (Parents/Legal Guardian):

Course Dates:
from (Monday)
to (Friday)
No of Weeks

Richard Language College 'Integra' Summer Intensive
32 Lessons
28 Lessons
20 Lessons
Activity Programme
Richard Organisation CLAS Courses
12-14 years:
Bournemouth
Teignmouth
14-17 years:
Bournemouth
Edinburgh
Exeter
Southport
Level of English
Name and Address of School:
Class:
Number of years learning English:
Name of English Teacher:

English Host Family
Accommodation Dates:
from
to
No of Weeks
Do you like animals? yes no
Do you like children? yes no
Do you smoke? yes no
Are you a vegetarian? yes no

Health or dietary requests:
Health

Have you suffered from:
Measles
German Measles
Mumps
Chicken Pox
Do you suffer from:
Asthma
Allergies: if YES, specify:
Other medical treatment:
Comments on student's character which may help to make the stay a success:

Travel Arrangements
Group:
Please contact our representative in your country for details.
Individual:
(Individual travellers must be more than 16 years old).
Do you require a FREE transfer from the airport/STATION - (For CLAS Courses only - see 'Transfers 1998' sheet) Yes No
Do you require an INDIVIDUAL (PAID) transfer from the airport/STATION? Yes No
If Yes, please give details.
Airport:
Flight No:
Arrival Time: hrs

Eurostar Waterloo Terminal
Eurostar No.:
Arrival Time: hrs

Permission for a student to go out alone in the evening.
Under 14 years old: permission not given.
14-15 years old: until 21.30 Yes No
16+ years old: until 23.00 h Yes No

I, the aforementioned, (student) agree to accept the conditions of stay of Richard Language College/Richard Organisation.
I, the, (Mother/Father/LegalGuardian) declare that my child has no illness which might preclude his/her following a language stay in England. I further authorise Richard Language College/Richard Organisation to arrange urgent treatment (when possible after consultation) in case of emergency. I agree to accept the conditions of stay of Richard Language College/Richard Organisation.
To guarantee your place, full fees must be paid on receipt of invoice. Payment instructions will be given with confirmation. In all cases of cancellation the enrolment fee is forfeited. Less than 2 weeks' notice of cancellation incurs a further charge of 1 week's accommodation. In the event of cancellation after arrival, NO refund of tuition fees can be made. In special cases the Principal exercises his discretion.

Personal Details - (CAPITAL LETTERS PLEASE)
Family Name:
First Name:
Sex:
Date of birth:
Nationality:
Address of Parents/Legal Guardian:
Tel: Home:
Business:
Emergency telephone number during time of stay (Parents/Legal Guardian):

Course Dates:
from (Monday)
to (Friday)
No of Weeks

Richard Language College 'Integra' Summer Intensive
32 Lessons
28 Lessons
20 Lessons
Activity Programme
Richard Organisation CLAS Courses
12-14 years:
Bournemouth
Teignmouth
14-17 years:
Bournemouth
Edinburgh
Exeter
Southport
Level of English
Name and Address of School:
Class:
Number of years learning English:
Name of English Teacher:

English Host Family
Accommodation Dates:
from
to
No of Weeks
Do you like animals?	yes no
Do you like children?	yes no
Do you smoke?	yes no
Are you a vegetarian?	yes no

Health or dietary requests:
Health
Have you suffered from:
Measles
German Measles
Mumps
Chicken Pox
Do you suffer from:
Asthma
Allergies: if YES, specify:
Other medical treatment:
Comments on student's character which may help to make the stay a success:
Travel Arrangements
Group:
	Please contact our representative in your country for details.
Individual:
	(Individual travellers must be more than 16 years old).
Do you require a FREE transfer from the airport/STATION - (For CLAS Courses only - see 'Transfers 1998' sheet)	Yes No
Do you require an INDIVIDUAL (PAID) transfer from the airport/STATION?	Yes No
If Yes, please give details.
Airport:
Flight No:
Arrival Time:	hrs
Eurostar Waterloo Terminal
Eurostar No.:
Arrival Time:	hrs

Permission for a student to go out alone in the evening.
Under 14 years old:	permission not given.
14-15 years old:	until 21.30 Yes No
16+ years old:	until 23.00 h Yes No

I, the aforementioned, (student) agree to accept the conditions of stay of Richard Language College/Richard Organisation. I, the, (Mother/Father/LegalGuardian) declare that my child has no illness which might preclude his/her following a language stay in England. I further authorise Richard Language College/Richard Organisation to arrange urgent treatment (when possible after consultation) in case of emergency. I agree to accept the conditions of stay of Richard Language College/Richard Organisation. To guarantee your place, full fees must be paid on receipt of invoice. Payment instructions will be given with confirmation. In all cases of cancellation the enrolment fee is forfeited. Less than 2 weeks' notice of cancellation incurs a further charge of 1 week's accommodation. In the event of cancellation after arrival, NO refund of tuition fees can be made. In special cases the Principal exercises his discretion.

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