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Agent Enrolment Form

Home / Contact Us / Form – Agent Enrolment

English In A Castle Agent Enrolment Form

For the attention of
Name of Agency*
Contact Name*
Agency Email Address*
Has a deposit / full amount been paid?
Student Details:
Family Name*
First Name*
Sex*
- Male
- Femail
Nationality
Date of Birth*
Mobile Phone Number
Parent/Guardian's mobile phone number if student under the age of 18
Hobbies and Interests
Allergies / special medical or dietary requirements*
- Yes
- No
Medical Details *
Would the student accept pets?*
- Yes
- No
Details*

for example: Allergic to cats, doesn’t like dogs etc.
Smoker?*
- Yes
- No
If 'yes' how many per day?*
Arrival Date*
Departure Date*
Transfer Required on Arrival?*
- Yes
- No
- Not Sure
Transfer Required on Departure?*
- Yes
- No
- Not Sure
Other Information
I confirm I have read and accept the English in a Castle Terms and Conditions*
- Yes

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