Booking Form / Booking Info / Living Learning English Limited

First Name: (*)

Surname: (*)

Gender: (*)

Male
Female

Date of Birth (*):

Nationality: (*)

Passport Number (visa applicants only):

Passport expiry date:

Address: (*)

Postcode: (*)

Country: (*)

Home Telephone:

Student Mobile: (*)

*Must be your own mobile - we will not use this for marketing.

Email: (*)

*Must be your own email - we will not use this for marketing.

Emergency Contact Name: (*)

Emergency Contact Telephone Number: (*)

Student Occupation:

Company:

Interests and Hobbies:

Native Language (s): (*)

Other Languages spoken and level (Elementary, Intermediate, Advanced):

Current level of English: (*)

How long have you been studying English?: (*)

I am currently studying English with: (*)

I AM ENROLLING FOR: (*)

Please specify which (English for Exams) exam:

Please specify which (English Plus) course:

Number of hours tuition per week:

Start date (usually Sunday):

End date (usually Saturday):

How many weeks do you want to study?:

WHICH LANGUAGE SKILLS DO YOU WANT TO WORK ON?:

Speaking
Listening
Reading
Writing
Grammar
Vocabulary

What do you want to achieve from the course?:

Which location would you prefer:

City
Countryside
Coast
Any

Please say whether you have any special requests about accommodation (eg pets in the home), dietary requirements or allergies:

Do you smoke?: (*)

Yes
No

(Please note that none of our teachers allow smoking inside their homes)

Young Learners: Does your child have any Special Educational Needs (e.g. dyslexia)? (*)

Yes
No

If yes, please advise details:

Does the student have any medical conditions? (*)

Yes
No

If yes, please specify details:

Which Activities/Excursions would you prefer:

Airport Transfers - I would like to book: (*)

Extras (please see brochure for fees). I would like to book:

A private bathroom
One extra night homestay
Two extra nights homestay
Accompanying adult (no tuition)
Accompanying child (no tuition)
Additional 1:1 tutorial
Christmas supplement
New Year supplement
Visa documents by express mail
Extra excursions

If you are booking extra excursions, please note requests here:

How did you hear of Living Learning English homestay courses?: (*)

Please confirm: (*)

I agree with the terms and conditions

Online Tuition