Course Enrolment Form 1. Course DetailsName of Course*Date of the Course (as shown in calendar) Date Format: DD slash MM slash YYYY Alternative dates requestedIf none of the existing dates suit you - please enter the date that would be good for you here.2. Student's personal detailsName of Student* First Last Gender*MaleFemaleDate of Birth* Date Format: DD slash MM slash YYYY Place and Country of Birth*Nationality and details of identity document/passport*(type, number, place & date of issue)Details of current valid UK visa(type, number, place & date of issue, period of validity) *(this information is needed for all non-UK citizens except those who belong to other member states of the European Union)Student's native mother tongue as spoken in the home*Student's blood group*Medical ConditionDetails of any current medical conditions and medication, including allergies and any special dietary requirements, etc., Please add any other special notes, if necessary3. Student's education detailsName and location of the school/college/university which you are presently attending?*Which academic year are you enrolled in now?*If none, please type in "none"What academic course and qualification are you studying for now?*If none, please type in "none"What is the language of instruction in your current academic course?*If none, please type in "none"4. Introducing yourself to novelEnglishPlease write a short letter to tell us about yourself and your interests and why you want to attend the course?*Please attach a photograph of yourself (and family if you like)Accepted file types: jpg, gif, png, jpeg.Please tell us which languages you speak and your ability in each one (beginner, medium, advanced, fluent)*Can you swim*YesNoIf you can swim, please indicate your ability: i.e. weak, capable, strong, do you hold any swimming qualifications?Do you have any pets of your own in your house?*YesNoWill this course be the first time that you have been away from home by yourself?*YesNoWill you bring a mobile phone with you?*YesNoIf yes, please give us this mobile phone number here5. Your parents and your homeHome - Street Address and House Number*Village / Town / City*County / Province*Postal code*Country*House telephone number*(please include country and area codes clearly)Name of your father*Only if you are under 18Nationality of your father*Only if you are under 18Father's home, work and mobile telephone numbers and his e-mail address*Only if you are under 18Name of your mother*Only if you are under 18Nationality of your mother*Only if you are under 18Mother's home, work and mobile telephone numbers and her e-mail address*Only if you are under 18Additional UK contactsName and address and contact numbers of any additional person in the UK whom we can contact while you are attending the NovelEnglish course (this applies particularly to overseas students).Parent / guardian visitPlease tell us if your parent/guardian wants to visit you during the course and if he/she wants to stay the night at Trelugga (this is only possible on the first night unless your family has arranged to stay in Chough Cottage). *Only if you are under 18Other relevant informationAny other relevant information (e.g. the address of a nearby hotel or B&B where your parents may be staying)6. Your travel arrangements to and from Trelugga We need to know clearly how you plan to reach Trelugga and how you plan to travel home (please see this page for the various travel options). If you need to be met at the nearest railway station (Redruth) or bus stop (National Express buses call at Coinagehall Street in Helston and at the main bus station in Penzance) we can arrange this free, as long as you definitely confirm it at least one week in advance of your arrival. You must also clearly tell us if you need to be taken to Redruth or Helston to catch a train or bus at the end of the course. We can also arrange to meet you at Exeter St Davids railway station or at Exeter airport or at some other agreed location, but obviously you will have to pay extra for this service. We may also be able to arrange for children under 16 years old to be escorted from and to other UK destinations.Will you be travelling alone or accompanied by an adult?*Only if you are under 18Details of travel to Trelugga*i.e. date(s), time of departure and arrival and means of travel for each section of the route, exact time and place of arrive (example: MON th Feb 2015 dep London Paddington station 1003 Hrs First Great Western train service to Penzance arr Redruth 1510 Hrs; dep Redruth railway station 1525 Hrs on First Great Western bus service number arrive Helston Sainsbury's supermarket at 1610 Hrs ; PLEASE COLLECT ) Details of travel from Trelugga*As in the above fieldDo you want us to provide pick and drop service by car? Please reconfirm this with details as to where and when both for arrival and for departure.For younger childrenDo you want us to provide an adult escort for you to travel to Cornwall, e.g. from London or Exeter or back? Please give details here and we shall contact you to confirm and advise of the cost of the.7. Insurance coverIt is a condition of enrollment in our course that each student has adequate accident and medical insurance to cover the duration of their stay with us. we also strongly recommend that you arrange insurance cover for your personal possessions like mobile phones or other valuables. This is your responsibility.Please give details of your insurance cover here.Terms and ConditionsPlease confirm that you and/or your parents or guardian have read and agree to our terms and conditions which indicate our duty of care and the limitations of responsibility to enrolled students and which explain the simple rules which every course participant must follow.By ticking this - I confirm I read the Terms and Conditions and agree with everything listed there.* Yes 9. DeclarationI declare that the above information provided by me is true to the best of my knowledge and belief and I have read and agree to novelEnglish terms and conditions and rules while attending the above course.10. Booking procedureAfter receiving this completed enrolment form we shall send you an invoice for the whole cost of the basic course (i.e. food, accommodation and tuition) but excluding the cost of any extras (like special travel arrangements) which may need time to work out and for which a second invoice may be needed. After receiving the invoice, you should pay a deposit of £100 to make a definite booking. We shall then send you a receipt and acknowledge your booking. The balance of the fee must be paid at least 45 days before the start date of the course. If you decide to cancel your booking, please do so at least 45 days before the start date of the course. If you fail to do so, we shall retain the deposit. If you cancel your reservation in time, you can reallocate your deposit to a later course or receive a refund in the amount of 50% of the deposit. This iframe contains the logic required to handle Ajax powered Gravity Forms.