English Course Form

Your details
Name*
First Last
Gender
Nationality*
Address
Postcode
Country*
Country
Date of birth*
DD slash MM slash YYYY
Phone
Email*
Emergency contact
Emergency Phone number*
Name of emergency contact*
First Last
Their level of English
- Basic
- Intermediate
- Advanced
Relationship (e.g. parent, spouse, friend)*
Your passport and visa details
Passport number
Passport expiry date
DD slash MM slash YYYY
Do you need a visa to study in the UK?
If yes, what kind of visa?
Visa number
Visa start date
DD dash MM dash YYYY
Visa expiry date
DD dash MM dash YYYY
Privacy
Untitled*
- I authorise Live Language to contact me about events, language exchange, social programme & special offers in addition to general information about my course.
- I do not want to be contacted by Live Language.
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.

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

English Course Form - Live Language