Killarney School of English Welcome




Application form

General Family Information
General Family Name :
E-Mail : Phone :
Address :
Town/City : ZIP Code :
Country :
How many people studying : How many people traveling :
 
Individual Family Details
(Adult 1)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
Beginner: I don't speak or understand any English Elementary: I can say a few basic things & understand short simple conversations Pre-Itermediate: I can understand simple conversations & can speak a little (with mistakes) on most every topics
Itermediate: I can speak quite well on most topics and understand the general sense of most everyday conversations Upper-Itermediate: I still make some mistakes but I can speak quite quickly and confidently on most topics Advanced: I can understand even complex topics and speak fluently with a few mistakes
(Adult 2)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
(Adult 3)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
(Child 1)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
(Child 2)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
(Child 2)
First Name : Surname 1:
Surname 2:
Age : Sex :
Course Code : GE1 GE2 GE3 Other  
Level of English :
 
Accommodation (please tick)
Host Family Hotel Self Catering I will arrange my own
If so where will you stay:
Details of medical Conditions (e.g. diabetes, asthma, epilepsy) :
Details of Allergies (e.g. medication, anesthetics, nuts) :
 
Travel Information
Do you wish to be collected :
Arrival place : Flight No :
Date : Time : :
 
Do you wish to be dropped off :
Departure place : Flight No :
Date : Time : :
 
Emergency Contact
Name :
Relationship (e.g. parent, spouse) :
Phone : E-mail : Fax :
 
Where did you hear about the School?
Internet : Agent :
Friend : Returning Student :
 
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