Please fill in this section carefully so that we have all your details. *obligatory
COURSE DETAILS
No of weeks* select weeks 1 2 3 4
Starting date* select starting date 29/06/2015 06/07/2015 13/07/2015 20/07/2015 27/07/2015 03/08/2015 10/08/2015 17/08/2015 I want to start on another date
If you cannot arrive on one of the starting dates in the box, tell us which date you want to arrive on.
I want to start on…
Our Teen Total Immersion courses run from 30/ 06 / 2024 to 11 / 08 / 2024. You can come for 1,2 or 3 weeks. You can choose: Junior Total Immersion (for 12-16 year-olds with A2, B1 and B2 level) Senior Total Immersion (for 16-19 year-olds with B1, B2 or C1 level) If you arrive and leave on Sundays, or as part of an organised group, your airport transfer is included in the course price. If you arrive on another day, we have to organise a private transfer for you. Each airport transfer costs €75. This will be added to the cost of your course when you pay.
STUDENT DETAILS
Name*
Family name*
Address:*
Date of birth*
Mobile phone number
Home phone number
Email*
Confirm Email*
Nationality*
Mother tongue(s)*
Parent/guardian name*
Parent/guardian mobile*
Parent/guardian email*
What is your current level of English?* (If you are not sure, you can test your English here) A1.1 Beginner A1.2 Elementary A2.1 Pre-Intermediate A2.2 KET B1.1 Intermediate B1.2 PET B2.1 Upper-Intermediate B2.2 FCE C1.1 Advanced C1.2 CAE
How did you hear about The Language Place?* friend my language school internet agent other (please tell us)
All our students have their own room unless two friends of the same nationality want to share a host family. In this case, the two friends usually share one room. If you share a host family with a student of another nationality, you will have your own room.
ACCOMODATION DETAILS
Tell us which you would prefer* select accommodation host family – shared room host family – own room I don’t need accommodation
If you want to share a room with a friend, write your friend’s name
Do you have any physical disabilities we need to tell your host family about? YES NO If Yes, give details here.
Do you have allergies? YES NO If Yes, give details here.
Are there any foods you can’t eat or really don’t like eating? YES NO If Yes, give details here.
Is it ok if your host family has pets? YES NO If No, give details here.
Will you have to take any medication during your teen total immersion course? YES NO If Yes, give details here.
In case of temperature or minor illness, can you take paracetemol or ibupfofen? YES NO
Do you have a European Health Insurance Card? YES NO
You need to bring a European Health Insurance card or the equivalent in your country with you when you come to Ireland. If you don’t have it, you will have to pay for medical treatment here.
ACTIVITIES DETAILS
Mark the activities you are interested in. football television reading basketball cinema travelling tennis theatre water sports cycling music IT photograpy golf clubbing horse-riding walking dance art Please give details of any other hobbies and interests you have here:
We match you to a host family with a teenager who has similar interests so that you have things to talk about or do with them. We send you your host family details before you come to Ireland so that you know which family you are going to stay with.
If there is anything else you want to tell us, write it here
Read the teen total immersion terms and conditions in English
Read the teen total immersion terms and conditions in Spanish
Read the teen total immersion terms and conditions in French
Read the teen total immersion terms and conditions in German
Read the teen total immersion terms and conditions in Italian
I have read the terms and conditions of the teen total immersion course*
info@thelanguageplace.ie
2 jocelyn place, dundalk, co louth, ireland
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