ABC College of English - Enrolment Form

Family Name: * Given Name(s): *

Telephone (home): * Mobile Number:

E-Mail Address: * Fax Number:

Address:

Date of Birth: Male Female

Nationality:* Passport Number:

Occupation:

First Language: Years of English studied:

Course Name: please select General English – Full Time General English – Part Time Morning General English – Part Time Afternoon Examination Preparation Courses Business English Course Pathway Programmes Ski/Snowboard Instructor Preparation Courses 50+ Programme Group Courses English + Work Placement English + Activity English + Ski/Snowboarding English + Golf

Starting Date: Length of study: week (s)

International Flight No. Arriving From:

Domestic Flight No. Arriving From:

Arrival Date: Arrival Time:

Do you require "Meet and Greet" service at Queenstown Airport? Yes No

I will arrange my travel and medical insurance before coming to New Zealand.

I would like ABC College of English to arrange my travel and medical insurance.

Please select your preference from below

I would like homestay accommodation: I would like lodge accommodation:

I would like information about: please select Hotel Motels Backpackers

I will arrange my own accommodation:

* If you wish to stay with a host family, please indicate your preferences below:

Do you smoke? Yes No (if yes, you may be asked to smoke outside)

Do you like pets?Yes No (Most host families have cats/dogs in their household)

Do you want to stay with a family with children? Yes No

Do you have any special dietary requirements? Yes No

Do you have any health problems? Yes No