Application Form Adults

This application form is solely for the booking of Courses at LAL Language Centres in accordance with the Terms and Conditions for students (which can be found at Terms and Conditions for Students).

Personal Details of Student

Exactly as shown on passport

First Name

Middle Name

Last Name

Date of birth

Country of birth

Passport number

Nationality

Phone/Mobile

Sex

Male

Female

Address

Address Line 1

Address Line 2

City

State

Post/Zip Code

Country

English Level

You can find information on levels in our brochure or at Language Levels

Course Information

You can find information on all our courses on our website: Adult Courses

Course Type

Course Name

Start date

End date

Insurance

I would like to purchase insurance through LAL

I have my own insurance

Information about LAL Insurance can be found here: Insurance

Insurers name

Policy number

Accommodation information

You can find information about accommodation options in our brochure, pricelist or online at: Learn English in Cape Town

Arrival Date (if different from your course dates)

Departure Date (if different from your course dates)

Accommodation Type

Accommodation Name

Name of accommodation (if known)

Food Choice

Room only

Half board

Full board

Are there any animals you cannot live with (for example, dogs)?

Yes

Please specify

Do you require smoking accommodation if it is available?

Yes

If you are booking a shared room, and you know with whom you would like to share, please state their name here:

Transfer information

Do you require transfers?

Yes

Transfers required

Arrival transfer

Departure transfer

Arrival Transfer information

From (Airport)

To (Airport)

Departure date and time

Arrival date and time

Flight code

Departure Transfer Information

From (Airport)

To (Airport)

Departure date and time

Arrival date and time

Flight code

Special Requirements and Health

Do you have any allergies, medical conditions, special dietary requirements, disabilities or special educational needs?

Yes

Please specify any special requirements

Further Information

Let us know anything else that may not be on this form.

Special instructions/requirements

Agency or Individual

Is this application from an individual or an Agency?

Individual

Agency

Agency Name

First Name

Last Name

Agency Email

Booking Currency

USD ($)

EUR (€)

Declarations and consent

I have read, understand and agree to the Terms and Conditions for Students and the privacy policy at (https://lalschools.com/terms-and-conditions-for-students) and the current Price of LAL Language Centres; the laws of the place where the LAL Language Centre where you will study is located will apply to any agreement arising out of this application form, and will abide by and study within the terms of any visa which may be required for my course.

First Name

Last Name