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Junior Programme

Family Name*

First Name*

Street Address*

City*

State/Province

Postal Code

Country:

Date of Birth*

Email Address*

Your Start Date

Your End Date

Gender
Male Female

Type of Course

	2 weeks	Additional Weeks
Junior Programme (All inclusive)	€1220	€565/week

Includes:

Accommodation
Host family with breakfast, packed lunch and evening meal in safe reach of the school

Language
20 English lessons/week+ all classroom materials + Teachers report+ Certificate

Leisure
An exciting and varied leisure programme 5 afternoons per week. Full-day excursion at the weekends + adult guide + transport fares+ entrance fees + equipment hire for sporting leisure activities

Comments or special requests?

Are you a first-time applicant? If yes, add registration fee of €65
Yes No

Will you require airport transfer? (€85/each way-Cork, €90/each way-Kerry)
Yes No

Tell us about yourself.

What do you hope to achieve by the end of the course?

Your level of English is?
Beginner Intermediate Advanced

What skills do you hope to improve?

Do you have any allergies?
Yes No

If so please elaborate. e.g cats, dust etc

Do you smoke?
Yes No

Any special dietary needs?
Yes No
If so please elaborate

To book your place on a course, we will need to secure an advance deposit (25%). After completing and submitting this application form we wil require proof of a payment transfer to the account below. Or, you may also pay by credit card Visa, Amex, MasterCard (phone or fax details in confidence). Full remaining fees can be paid at any time up to 3 weeks before arrival. Please note that cancellation prior to arrival may incur an administration fee.

Bank account details for transfer of deposit/fees:

Bank name & address: AIB Bank, Main Street, Schull, SW Cork, Republic of Ireland.
Account name: Atlantic English Language Services
IBAN number: IE21AIBK93636703239094
Swift:AIBKIE2D

Terms Agreement


Revised on: 12 April, 2007

CANCELLATIONS
Bookings may be cancelled up to 3 weeks prior to commencement of  the course  but you will lose the 25% booking deposit. For cancellations received between 14-21  days before commencement of course 60% of full amount will be refunded; for cancellations received 1 - 7 days before commencement of course 30% of full amount will be refunded. No refund for any cancellation after the course has commenced.  This includes days missed during the course, late arrival or  early departure.  In some circumstances we may allow you to continue your course at a later date at no extra cost. Long term students may discuss  taking some holiday weeks during their course and  only a retainer fee for accommodation  will be charged. There lessons will then recommence on their return with no lesson weeks lost.

REFUNDS
I understand that all fees and charges will not be refunded after my course starts.  I am aware, however, that Atlantic S.E.A.L will allow me to continue my course at a later date should unavoidable circumstances cause premature departure.
	
INSURANCE
* Insurance is the responsibility of the course participants. Students should arrange medical insurance in their own country before departure. EU students should bring E111 forms.

* Travel insurance is also recommended.

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Atlantic School of English and Active Leisure, Cooradarrigan, Schull, County Cork, Ireland.
Telephone: +353 (0) 28 28943 Fax: +353 (0) 28 28946