Iscrizione Online

Student Details

Date of birth(DD/MM/yyyy):
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 01 02 03 04 05 06 07 08 09 10 11 12 / 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Age:

Gender:
Male Female

First parent email address:

Confirm first email address:

Second parent email address:

Confirm second e-mail address:

Email address for placement test:
The link for the placement test will be sent to this email ONLY

Telephone Numbers (to include country code)

Contact details (in case of emergency):

Flight details: Arrival

Flight details: Departure

Previous english examinations taken:

KET: PET: First cerificate (FCE): CAE: CPE: BEC: TRINITY: IELTS: TOEIC:

Results:

Health information

Health problems (e.g. diabetes, allergies, etc): NO YES

Learning difficulties: NONE DYSGRAPHIA DYSLEXIA NON VERBAL LEARNING DISABILITIES ADHD OTHER

If other, describe the problem:

Mental health difficulties: NONE ANXIETY AUTISM SPECTRUM DISORDER (ASD) EATING DISORDER OTHER

If other, describe the problem:

Blood group (if available):

General information

Father’s Name:

Father’s Surname:

Profession:

Mother’s Name:

Mother’s Surname:

Profession:

Student personal information

Is this your first stay away from your family?
Yes No

Number of stays abroad:

In which countries?

Favourite Hobbies and sport:

Do you play an instrument?

Please describe your personality

Do you have any pets at home?

What are your favourite foods?

What food do you not like?

Is this your first time participating in the Claddagh school of English?

Yes No

Do you wish to return to the same host family if available?

Yes No

Do you have any friends who are participating in the Claddagh school of English?

Yes No

If Yes, name of other students:

Upload your photo:

Acceptance

Do you confirm the data and the conditions specified above?

Yes No

Form of consent to tratment of personal data and images of the student (not required)

I, the undersigned consent (on behalf of my daughter/son) to the processing of personal data and images, produced during the course which MAY be posted on the website/or facebook pages of the school

I consent I do not consent

School rules

I HAVE READ AND DISCUSSED THE SCHOOL RULES WITH MY CHILD.

Agree Disagree

Terms and Conditions

I HAVE READ AND I AGREE THE TERMS AND CONDITIONS – EN – IT – ES

Agree Disagree

Captcha code

Change Code

Please send a deposit of 200 euro indicating the name of the child to whom it refers and email the receipt to Mary Magee at halcyon141@gmail.com

Medical insurance: every student must bring their national health card