Registration Form for Coromandel Outdoor Language Centre

Registration Form for Coromandel Outdoor Language Centre

Fields marked with a red asterisk * are required

PERSONAL DETAILS
Given name * Family name *
Date of birth * Gender Male Female *
  A signed, separate parent or guardian consent form will be required for students under 18 years of age
First language * Nationality *
Home address * Occupation
  * Telephone *
  Fax
Country * E-mail *
How did you hear about Coromandel Outdoor Language Centre?  

CONTACT DETAILS IN CASE OF AN EMERGENCY
Name * Relationship to student *
Address *    
  Telephone *
  Fax
Country * E-mail

LEVEL OF ENGLISH (You will be given a short test and interview on your first day)
Reading - Writing Beginner Elementary Intermediate Advanced *
Speaking - Listening Beginner Elementary Intermediate Advanced *
 
COURSE DETAILS (Courses start on Mondays - except Public Holidays)
* Course Start Date End Date Weeks
Full Time with Activities
General Course
General Plus Course (Friday Activity)
English Plus 3 Course (Tues, Wed, Fri Activities)
Examination Preparation Course
Part Time, Tuition only
English plus Surfing/Body boarding
Private Lessons
Number of lessons per week:
Farmstay (for students not attending classes at school)
Special Courses by arrangement

HOMESTAY
Do you want us to arrange homestay accommodation?
Yes No *
Accommodation, with breakfast and dinner, Monday - Friday and 3 meals on Saturday and Sunday  
Number of weeks
First night (date)
Last night (date)
Departure date
   
To help us arrange a suitable host family for you please answer the following questions:
Do you smoke?
Yes No
Do you mind if your host family smoke?
Yes No Either
Do you prefer children in your host family?
Yes No Either

Do you prefer cats/dogs in your host family?

Yes No Either
Do you have any special food needs?
Yes No
If yes, please give details:
 
Do you have any special medical problems/allergies?
Yes No
If yes, please give details:
 
Your sporting interests / hobbies:
 
Special requests:
 

TRANSFER
Please inform us of your travel plans as soon as possible
Arrival transfer from Auckland Airport is free to students enrolled for 12 weeks or more  
Do you want us to meet you and organise your transport from Auckland to Whitianga?
Yes No *
Arrival day Date:
Arrival time at Auckland airport    Flight number  
 

RETURN TRANSFER
Do you want us to organise your return transfer?
Yes No *
Departure day Date:
Departure time at Auckland airport    Flight number  
 

MEDICAL AND TRAVEL INSURANCE
All International Students studying in New Zealand have to have an appropriate and current Medical and Travel Insurance Policy. Please refer to our conditions of enrolment.
Do you want us to organise an insurance policy with Uni-care for you?
Yes No *
Policy type:
NZ Student NZ Visitor
Please advice:  
First date of travel   Final date of travel   
 
Please refer to the Uni-care website for policy details: www.uni-care.org

PAYMENT OPTIONS
Please select your preferred payment method.
We will send you details on how to make payment once we have received your application.

Bank Draft Direct Credit Credit Card *

ACCEPTANCE

By submitting this form I accept the terms outlined in the Conditions of Enrolment and understand that Coromandel Outdoor Language Centre will make every effort to accommodate my requests and acknowledge that I have read both the Conditions of Enrolment and the Code of Practice summary.

I have read the Conditions of Enrolment and the Code of Practice summary



 

 

Coromandel Outdoor Language Centre is a member of English New Zealand, a federation of independent language schools

Coromandel Outdoor Language Centre is a member of IALC, the International Association of Language Centres

Tourism Coromandel


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