Booking Form for Moira House Centre 2013

To book a place at ACCORD ISS 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 / 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 £220 return
Gatwick £180 return
London City £250 return
Stansted £240 return
St Pancras £260 return
Ebbsfleet £230 return
Ashford £220 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		 1st July - 6th July (Shorter week - Monday arrival)£605
7th July - 13th July £705
14th July - 20th July £705
21st July - 27th July £705
28th July - 3rd August £705
4th August - 10th August £705
11th August - 17th August £705
Intensive English Programme (IEP) 3 hours per week£100

Optional Activities


Activity Hours/Week Price Number of Weeks
Sailing 2 £50
Sailing 4 £100
Sailing 6 £150
Canoeing 2 £50
Canoeing 4 £100
Canoeing 6 £150
Windsurfing 2 £50
Windsurfing 4 £100
Windsurfing 6 £150
Mountain Biking 2 £60
Tennis 6 £135
Swimming Lessons
(beginners only)		 1 £40
Swimming Lessons
(beginners only)		 2 £80
Swimming Lessons
(beginners only)		 3 £120
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