Book a course

Please read the terms and conditions before completing this booking form.

Please complete all of the fields marked with a *. When you click "send booking" the page will check that you have filled everything out. If you haven't, the booking will not send. Please re-check the page and then you can send the booking again.

Personal Details
Family name*:	Please enter your family / last name.
First name*:	Please enter your first name.
Address*:	Please enter your address.
Country*:	Please enter your country.
Your telephone numbers:	(home) (mobile)
Parents' telephone numbers*:	(home) Please give us your parents' home telephone number. (work) (mobile)
Your email address*:	Please enter your email address.Please enter a valid email address.
Parents' email address*:	Please enter your parents' email address.Please enter a valid email address.
Your nationality*:	Please enter your nationality.
Sex*:	Please select male female Please select your sex.Please choose your sex.
Date of birth*:	Please enter your date of birth.Please enter in form dd/mm/yyyy.
Main language spoken*:	Please enter your main language.
Where did you hear about us?	Please select Teacher / school Friends I've been before! Facebook Google Internet Agent Other Where did you hear about us?Where did you hear about us?
Course details
Course*:	Please select a course Standard English (ES.20) Intensive English (EI.30)
Course start date*:	Please enter the course start date.Please enter in form dd/mm/yyyy.
Course end date*:	Please enter the course end date.Please enter date in form dd/mm/yyyy.
Accommodation
Please tick if you need one of these special diets. There is an additional charge of £15 per week for diets marked with **. It is important that you give us this information now.	vegetarian vegan ** diabetic lactose/gluten free ** Halal **
If you have, or have recently had, any medical condition (physical or mental) which might affect your studies, or which your host family should know about, please give details:
If you have any special wishes regarding your accommodation (e.g. allergies, no dogs etc.), please give details:
Your school
How many years have you been learning English?*	How long have you been learning English?Numbers only please: e.g. 4.
Full name of your school:
Full address of your school:
Name of your English teacher:	Mr Mrs
Payment
I wish to pay*:	by credit card we will contact you to arrange payment by bank transfer to: Cicero Languages International HSBC Bank PLC 105 Mount Pleasant Tunbridge Wells TN1 1QP IBAN-No.: GB73MIDL40443781789643 BIC-CODE: MIDLGB2160J Please add £20 sterling to cover bank charges How do you want to pay?
The following must be completed by your parent / guardian
First name and family name of parent / guardian*:	Please enter the full name of your parent / guardian.
Terms and conditions*:	I have read and agree to the terms and conditionsYou must accept the terms and conditions.
Please fill out all fields marked with a *.
Please check you have completed all fields with a * before clicking "send booking".