Enrollment form

Thank you for deciding to enroll at NFLS. Please complete all applicable fields.


Personal Information Referring organization
First Name
 Last Name
Email
 Confirm email
Gender
 Birthdate (dd/mm/yyyy)
Phone Number
  
Home Address  
Street
 City
Province, State, Canton or District
 Country
Postal code or P.O. Box
  
Emergency Contact Information  
Emergency Contact name
 Emergency phone number
What program do you want to study?  
Your level:

 Start Date: (dd/mm/yyy)
Finish Date:
 Number of weeks:
Courses  
Courses

 How did you learn about Niagara Falls Language School?


Homestay Information:  
Would you like Homestay? (All homestays include three meals per day)
 If you are not using Homestay please select one of the following?
Do you smoke?
 Can you live with pets?
Do you have any special dietary needs? (Explain)
 Do you have any allergies or medical conditions? (Explain)
Are children in the house OK?
 What are your hobbies? (Explain)
Expected arrival date:(dd/mm/yyyy)
 Expected departure date:(dd/mm/yyyy)
Total number of weeks:
  
Arrival and flight information. If you do not know this information yet leave it blank however the school will require this information at least one week prior to your start date.  
Will you need airport service?
  
Airline:
 Flight#:
Flight date:
 Time of arrival:

I confirm that I have read and I accept the Conditions of Enrollment as well as the Refund policy of the Niagara Falls Language School.