English Course Form

Your details
Name*
Title First Last
Address
Postcode
Country*
Country
Date of birth*
Nationality*
Phone
Email*
Emergency contact
Emergency Phone number*
Name of emergency contact*
First Last
Their level of English
- Basic
- Intermediate
- Advanced
Your passport and visa details
Passport number
Passport expiry date
Do you need a visa to study in the UK?
If yes, what kind of visa?
Visa number
Visa start date
Visa expiry date
Privacy
Untitled*
- I authorise Live Language to contact me about my course. For example, dates, changes, cancellations, activities related to the course, next term information, course feedback, classroom information and payment.
- I authorise Live Language to contact me about events, language exchange, social program and special offers in addition to general information about my course.
- I do not authorise Live Language to contact me. I understand that this means I may not be informed of class cancellations, etc.
You can notify us if you change your mind regarding your previous privacy settings at the school at any time. Live Language may contact you after you have finished studying at the school if you have any outstanding payments.

Accommodation
Do you need accommodation?
- Yes
- No
Your preferred zone
- Zone 1 (max. 25 minutes travel time from school)
- Zone 2 (within 25-60min travel time to school)
Section Break
Your first option
Your second option
Start date
Finish date
Do you smoke?
- Yes
- No
Do you object to pets?
- Yes
- No
Do you have any special needs? (eg.: diet, allergies, etc)

Insurance
Do you need insurance?
- Yes, I would like to be covered
- No, I take responsibility for my insurance.
We strongly advise all students to take out insurance to cover them against sickness, accidents or cancellations. A good student insurance policy will refund the remaining fees if you have to go home early for a medical or other serious reason. Please note that your course fees are not refundable under any circumstances.
Transfer
Would you like a transfer from the airport on your arrival?
- Yes
- No
Which airport?
Untitled
- One way
- Return
Additional information
Where did you first hear about Live Language?
Name of Education Tour Operator
Payment details
How are you going to you finance your lessons?
Untitled*
- Agent pays net
- Student pays gross

Your details