Booking Form for Moira House Centre 2012

To book a place at International Summer School at Moira House Eastbourne please complete the following form. We will contact you with regards to payment which can be done by credit card via fax. Please do NOT enter your credit-card details below or e-mail them to us!

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 12345678910111213141516171819202122232425262728293031 Month 123456789101112 Year 198519861987198819891990199119921993199419951996199719981999200020012002200320042005
First Language:
Knowledge of English:	Beginner Elementary Intermediate Advanced
Is the student in good health:	Yes No
If "No", please provide details:
Student Mobile Number:
Do you require insurance? (see Terms and Conditions for details):	Yes No
Parental Details
Name of parent or guardian:
E-Mail Address:
Postal Address:
Home Telephone:
Work Telephone:
Mobile Number:
Fax:
Emergency Contact Details
Name of emergency contact:
Address:
Home Telephone:
Work Telephone:
Mobile Number:
Fax:
How did you hear about International Summer School [ISS]:
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 I.S.S. staff who transfer them to the school. On departure 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 transfer?	Yes No
If "Yes" please choose airport/train station:	Heathrow (£200 return) Gatwick (£160 return) London City (£230 return) Stansted (£220 return) St Pancras (£240 return) Ebbsfleet (£210 return) Ashford (£200 return)
Additional waiting service where International Summer School staff remain in the airport or train terminal building until the flight or train departs - this particularly applies to Unaccompanied Minors (UMs):	Waiting service (£40)
Weeks Required Please select your preferred dates.
Total number of weeks:
Summer:	2nd July - 7th July £575.00 (Monday start in first week of course) 8th July - 14th July £675.00 15th July - 21st July £675.00 22nd July - 28th July £675.00 29th July - 4th August £675.00 5th August - 11th August £675.00
FCE Preparation Course (Supplement payable £75 per week): If you want to follow our general course please leave this box blank.
Optional Activities You can only do one activity per week.
Sailing 2 hours per week (1 afternoon) £45	Number of weeks:
Sailing 4 hours per week (2 afternoons) £90	Number of weeks:
Sailing 6 hours per week (3 afternoons) £135	Number of weeks:
Canoeing 2 hours per week (1 afternoon) £45	Number of weeks:
Canoeing 4 hours per week (2 afternoons) £90	Number of weeks:
Canoeing 6 hours per week (3 afternoons) £135	Number of weeks:
Windsurfing 2 hours per week (1 afternoon) £45	Number of weeks:
Windsurfing 4 hours per week (2 afternoons) £90	Number of weeks:
Windsurfing 6 hours per week (3 afternoons) £135	Number of weeks:
Mountain Biking 2 hours per week (1 afternoon) £55	Number of weeks:
Tennis 6 hours per week (3 afternoons) £125	Number of weeks:
Swimming Lessons (beginners only) 1 hours per week (1 afternoon) £30	Number of weeks:
Swimming Lessons (beginners only) 2 hours per week (2 afternoons) £60	Number of weeks:
Swimming Lessons (beginners only) 3 hours per week (3 afternoons) £90	Number of weeks:
Golf 6 hours per week (3 afternoons) £160	Number of weeks:
Horse riding 1 hour per week (1 afternoon) £55	Number of weeks:
Horse riding 2 hours per week (2 afternoons) £110	Number of weeks:
Horse riding 3 hours per week (3 afternoons) £165	Number of weeks:
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