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English School Malta - Learn English


Section 1: STUDENT’S PERSONAL DETAILS
Name:
Surname:
Nationality:
Date of Birth:
Gender:
Address:
Email:
Telephone:
Fax:
Passport No:
Place of Issue:
Date of Issue:
FOR EMERGENCIES
Name:
Surname
Email:
Telephone:
Fax:
Type of Course:
Course Dates:
Weeks:
Do you have a learning difficulty? (Please, answer 'Yes' or 'No')
Do you have a disability? (Please, answer 'Yes' or 'No')
If you answered 'Yes' to the above questions, please give details.
Section 2: Accommodation
Accommodation:
Number of Accommodation nights:
Section 3: AIRPORT TRANSFERS
Do you need airport transfers? (Please, answer 'Yes' or 'No')
Airport transfers (Arrival and departure) are optional and at an extra cost of 44 Euro.
Section 4: VISA
Do you need Visa application assistance? (Please, answer 'Yes' or 'No')
Section 5: HOME STAY ACCOMMODATION DETAILS
Do you have any medical problems or allergies?
Do you smoke? (Please, answer 'Yes' or 'No')
Would you live in a home with young children? (Please, answer 'Yes' or 'No')
Are there any foods you cannot eat? (Please, answer 'Yes' or 'No')
Would you live in a home with a dog or cat? (Please, answer 'Yes' or 'No')
*If you have any other important special requests or if you have answered Yes to these
questions, please give details.
Section 6: TERMS AND CONDITIONS - CLICK HERE TO READ
Section 7: COURSE PAYMENT DETAILS
How do you wish to pay? (Bank Transfer or by Credit card)

For Bank Transfer payment

Account Name: English Plus Int. CO. LTD Account No.: 075 010942 451

Bank: HSBC Bank Malta Plc. Address: Naxxar Road, San Gwann Malta.

Bank’s Swift Code: MMEBMTMT

IBAN: MT33MMEB44750000000075010942451

Please send a copy of the transfer documents to us as soon as this transaction is arranged with
your bank. This will help us to track the payment and will be considered as proof of payment.

For credit card payment only

Please charge my Visa / MasterCard: (please give card type)
Card number:
Card Expiry Date:
Name of card holder:
Date of Birth:
Address:
Email:
Telephone:
Fax:
Name of Bank who issued the card:

Total course fee amount paid in Euros:

On receipt of your deposit we will send you an enrolment certificate, accommodation details if applicable, and an invoice. The balance is payable before the start of your course.

Date of arrival:
Date of Departure:
Flight No:
Time of Arrival:
Section 8: DECLARATION
- By submitting this form, I agree to accept responsibility for all fees for the course as indicated.
(tuition, accommodation, transfers) and will pay them by the deadline.

- I have read, understood and accept the terms and conditions of English Plus Language Centre
as shown above in section 6 of this application form.

- I understand and accept that any pictures/photos taken during any activity of English Plus
Language Centre can be used for the promotion of any kind of educational activity carried out by English Plus International Company Limited.

- In case of accident or illness I give permission to any appropriate medical centre to examine or
treat or make necessary referrals to outside physicians as indicated.

- I give permission to release information regarding health.

If you are under 18, you need to download our Student Enrolment Form and send to us by email to: info@englishplusmalta.eu

English Plus Language Centre
Dean Hamlet Aparthotel, Qaliet Street,
St. Julian's
Malta

Your parent or guardian must sign on your behalf. Thank you.