Student Registration Form

Student Registration
Personal Information. (*) Required field.
Date
First Name *
Last Name *
Address *
City *
State/Prov *
Country *
Postal Code *
Tel *
Fax

E-mail *
Date of Birth	(mm/dd/yyyy)
Gender *
Nationality
Language(s) Spoken
Your level of english is:
Do you smoke?	Yes No
Do you have allergies?	Yes No
Do you like pets?	Yes No
Emergency contact information
Full name *
Relationship *
Tel *
Fax
E-mail
Arrangements
Do you require airport reception?	Yes No
(A non refundable CDN$100.00 fee applies for airport reception). Please provide complete flight details (airline, flight number, arrival date/time) and a recent photograph.
What kind of accommodation do you prefer?
Number of weeks required
Comments
Write any comments or questions in the area bellow
All administration fees are non-refundable. Homestay fees for the first four weeks must be paid three weeks in advance.