Booking Form for Bethany Centre 2013

To book a place at ACCORD ISS at Bethany Centre please complete the following form.

Booking Form

Before completing the form please read the Terms and Conditions.

Student Details
Family Name:
First Name:
	Boy Girl
Nationality:
Date of Birth:	Day / Month / Year
First Language:
Knowledge of English:	Beginner Elementary Intermediate Advanced Proficiency
Is the student in good health:	Yes No
If "No", please provide details:
Student Mobile Number:

Parental Details
Name of parent or guardian:
E-Mail Address:
Postal Address:
Home Telephone:
Work Telephone:
Mobile Number:
Fax:

Emergency Contact Details (if different from above)
Name of emergency contact:
Address:
Home Telephone:
Work Telephone:
Mobile Number:
Fax:
How did you hear about ACCORD ISS?
Have you been a student at ACCORD ISS before?	Yes No

Airport Transfer: Meet and Greet Service We are happy to meet children at Heathrow, Gatwick, Stansted and London City airports, and Eurostar Train stations at Ashford, Ebbsfleet and St Pancras. Children are met by ACCORD ISS staff who transfer them to the school. On departure ACCORD ISS staff will accompany children to the Airport/Train Station and assist with check-in and stay with them until they go through to passports. Discounts are available if students are travelling together.
Do you require airport/Eurostar transfer?	Yes No
If "Yes" please choose airport/train station:	Heathrow £205 return Gatwick £170 return London City £180 return Stansted £230 return St Pancras £260 return Ebbsfleet £160 return Ashford £130 return
The cost for our "meet and greet" transfer service includes pick up of your son/daughter by our staff on arrival and transfer to ACCORD ISS. On return to the airport or train station on departure, our staff will assist with check in and will stay with your son/daughter until he/she goes through to Passport Control. If you require our additional waiting service where ACCORD ISS staff remain in the airport or train terminal building until the flight or train departs - this is available by ticking the box:
	Waiting service £45

Weeks Required Please select your preferred dates.
Total
Summer : All prices include insurance	14th July - 20th July £715 21st July - 27th July £715 28th July - 3rd August £715 4th August - 10th August £715
Intensive English Programme (IEP)	3 hours per week£100
Single en-suite room: Supplement payable £60 per week:	Yes No
Further weeks, e.g. 1-6 July and 7-13 July, 11-17 August are available at Moira House Centre and Newlands Centre. Staff will transfer students between schools free of charge.

Optional Activities
Activity	Hours/Week	Price	Number of Weeks
Intensive English (28 July – 10 August)	3	£100
Sailing	2.5	£70
Sailing	5	£140
Canoeing	2.5	£70
Canoeing	5	£140
Windsurfing	2.5	£70
Windsurfing	5	£140
Mountain Biking	2	£60
Tennis	6	£135
Golf	6	£165
Horse riding	1	£60
Horse riding	2	£120
Horse riding	3	£180

Methods of Payment: Do you wish to pay by:
Credit card?	Yes No
International Bank Transfer?	Yes No
Other method:

By submitting the form you state that you have read and agree with the Terms and Conditions. Records will be maintained and divulged to third parties only within the provisions of the Data Protection Act