Classic English Language School

Please fill out the following enrolment form if you wish to enrol on-line with us. Your privacy and our discretion is assured. Thank you

Personal Details
Family Name
Given Name
Gender	Male Female
Postal Address
City, Country
Telephone Number
Fax Number
Email Address
Date of Birth
Age
Nationality:
Father's name:
Mother's name:
Contact Phone Number
Agent Contact Details:

English level and experience
What do you consider your level of English is?

Which courses or options are you interested in? (tick the relevant checkbox)
General English
High School Preperation
General Training IELTS
General English with TOEIC
Academic IELTS
NZIM Cert. Management
NZIM Cert. Small Business Management
Introduction to Computers
Holiday Programme
Start Date
Finish Date
Compulsory Insurance arrangements

Accomodation

Homestay at $180 per week	Yes
Hotel/Motel
Youth Hostel
Do you smoke?	Yes No
Do you like pets?	Yes No
Do you have any health issues?	Yes No
If YES, please specify:

Declaration: I have read and accept the Conditions of Enrolment. I agree to have my information used for purposes relating to my enrolment as a student at Classic English Language Schools

NZI Building, Level 4, 11 Garden Place, PO Box 5654, Hamilton, New Zealand Phone: +64 7 8393988, Facsimile: +64 7 8393986, Email: director@classic-english.co.nz