summer english course application form

Mr/Mrs/Ms/Miss/Other

First Name*

Family Name*

Nationality*

Address Line 1

Address Line 2

Town/City

Postcode

Country

Telephone*

Email*

Mobile

Date of birth*

Male Female

Sex

Occupation

First Language

Special Diet/Allergies

Yes No

Do you have any medical conditions we should know about?

If yes, please describe them here

How did you hear about Kheiron School of English?

What is your English level approximately?
Beginner
Elementary
Pre-intermediate
Intermediate
Upper-intermediate
Advanced

English Intensive Courses:
Intensive Executive English (1 Week Course)
Intensive General English (2 Week Course)
Intensive General English (3 Week Course)

Start Date (DD/MM/YY)

End Date (DD/MM/YY)

Please choose your type of accommodation
Homestay
Oxford University college room with en suite

If college, please indicate if you would like a three course evening meal:

Yes
No

Accommodation start date (DD/MM/YY)

Accommodation end date (DD/MM/YY)

You must have medical and travel insurance if you book a course with us so please confirm that you have adequate cover
I have adequate cover

Payment

Registration cannot be accepted without payment of:
1. a deposit of £350, if booking is more than six weeks from course start date OR
2. the full course cost if booking is less than six weeks from course start date
I am paying deposit only (remaining cost due on arrival)
I am paying full course cost now

 Please indicate the amount you are paying: £350 if deposit only

Cheque (UK £ Sterling only) made payable to Kheiron School of English Ltd. Please write your name on the back of the cheque

Cheques to be sent to:
Kheiron School of English Ltd, 9 Park End Street, Oxford OX1 1HH
England

Bank transfer - Please click here for bank transfer details (opens in a new window)

Registration will be confirmed on receipt of cheque or bank transfer for deposit or full course amount

I do not wish to be contacted by post in the future (tick if you do not wish this)
I do not wish to be contacted by email in the future (tick if you do not wish this)
I have read and accept the terms & conditions