Country Cousins

STUDENT ENROLMENT FORM

Surname: First Name: Date of Birth:
Nationality: Gender:Male Religion:
Home Address(including postcode):
Daytime Tel: Evening Tel: Mobile:
Fax: Email: Smoker: Yes No
Name, telephone number and email address of person to contact in emergencies:
Parents' Professions:
Please indicate sports, hobbies or interests:
Are there any special health/dietary requirements or allergies?
Name and address of student's school in their country:

1) Channel School of English, Ilfracombe (Host Family accommodation with Full Board)

Activity Programmes
(Please tick one option)
English tuition hours per week
12 hours
15 hours
18 hours
21 hours

Adventure Sports (6 hrs/wk in 3 sessions)
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-

Ballet and Modern Dancing

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-
-

Discovering Devon
-

Football (6 hrs per week in three sessions)
-
-
-

Golf (6 hrs per week in two sessions)
-
-

Riding (6 hrs per week in two sessions)
-
-

Surfing (6 hrs per week in three sessions)
-
-
-

Tennis (6 hrs per week in three sessions)
-
-
-
One-to-One Tuition
Would you like to have One to One tuition only? If so, please choose number of hours per week:
15 hours
18 hours
21 hours
Would you like to have One-to-One tuition on top of your Standard, Classic or Intensive course?
Number of extra One to One sessions per week required:

Tennis/Riding Level: Beginner Intermediate Advanced. If you require extra 1-to-1 tuition, indicate hours per week required:

2) St. Michael's Residential, Barnstaple (Residential accommodation with Full Board)

Adventure Sports, Music and Arts Residential for 9 to 14 year olds.
15 hours tuition

3) Complete Immersion Programmes (Host Family with Full Board Accommodation)

Homestay Only
(no tuition)
or
Stay with an English Teacher (please choose weekly tuition)
10 hours tuition
15 hours tuition
20 hours tuition

 

TRAVEL DETAILS

We recommend you always arrive & depart on a Saturday. Please arrange flights to arrive before 2 pm and depart after 1:30 pm
Do you need transportation from
the airport to North Devon?
Which service do you
require?
Country Cousins Bus
(Saturdays only)
Private
Car
Airport
Escort
Other
(please specify)
Yes No
Arrival only
Closest airports to North Devon are
Exeter (90 mins) & Bristol (2 hrs)
Departure only
Arrival and Return
Date of arrival: Time of Arrival: Flight number:
Arrival Airport: Exeter Bristol Heathrow Gatwick Other (please name):
Date of departure: Time of departure: Flight number:
Departure Airport: Exeter Bristol Heathrow Gatwick Other (please name):

TRAVEL INSURANCE

Do you want us to arrange your travel insurance No Yes (please make sure you add this fee to your full payment or deposit)

 

STUDENT VISAS

Do you need a student visa Yes No (please note that non European Union members will require a student visa)

 

HOST FAMILY CHOICE

Would you like to return to a host family? If so, what is their name & address? Mrs

Do you have any special requirements? (i.e. you want/not want pets, want/not want a student of another nationality, etc):

 

DECLARATION

In these conditions “You” means the student or the student’s guardian and “We” means Country Cousins Ltd.

Country Cousins acts in all circumstances as an intermediary between guests and hosts on the basis of the representation and undertakings contained in Country Cousins published materials relating to any particular arrangement.

  1. Registration: When booking you must pay a deposit of £100 or 150€ per student. Students will not be met at the airport, permitted to attend classes nor to enter accommodation unless payment has been paid four weeks before the course starts.
  2. Payments: Payment must be made in pounds sterling or euros only.
  3. Cancellations: In the event of cancellation, the deposit is not refundable. If cancellations are received within 4 weeks, one week’s accommodation and/or tuition will be deducted and the balance of the fees refunded. You are therefore strongly advised to take our insurance to cover such loss.
  4. Our rights to expel students: Country Cousins reserves the right to expel students who:

    5. a) Do not obey the rules of the schools

    b) Break any British laws

    c) Abuse the school’s staff, host families, or who wilfully damage property.

    d) Bring the school into disrepute

  5. In the event of expulsion being necessary, no course fees will be returned, and additional travel costs must be paid for via Credit Card or cash.
  6. Liability: Country Cousins does not hold itself responsible for any injury, accident, loss, damage, delay, inconvenience or expense, which the guest may suffer or incur as a result of negligence or breach of duty of the host, or as a result of any defect in the host’s property which does not arise directly from any representation or arrangement made or undertaken in Country Cousins’ capacity as intermediaries.
The guest is responsible for any injury, accident, loss, damaga, delay, inconvenience or expense which the host may suffer or incur during the stay.

 

I agree to my child taking part in all the programmed activities and also any other activities organised by the school.
I have read and understood the terms and conditions above and I accept them.