Welcome to Waterford English Language Centres Call us today: +353 (0)51 877288

Waterford English Language Centres
Washington Lodge, Sweetbriar Park, Waterford, Co. Waterford

Adult Booking Form

Personal Details
Name*
FirstLast
Date of Birth*
Email*
Gender*
Address*
Street AddressAddress Line 2CityZIP / Postal CodeCountry
Telephone (please include international code):
Nationality:
Your level of English:
- Beginner
- Elementary
- Intermediate
- Advanced
Have you taken any English examinations in the past? If so, please describe:
Course Details
Which course do you wish to do?*
Start Date*
Finish Date*
Accommodation & Arrival
Do you require accommodation?*
- Yes
- No
Type of accommodation required
Do you mind if the host family have pets?*
- I don’t mind
- I prefer no pets
Date accommodation is required from*
Date accommodation is required to*
Any health issues or allergies we should know about?
Do you require a vegetarian or specialist diet? Please describe if so.
Do you smoke?*
- Yes
- No
Do you require airport pickup?*
- Yes
- No
Do you require medical insurance?
- Yes
- No
Where did you hear about us?*
Agent name
Terms and conditions agreement*
- I have read and accept all the terms & conditions.
Terms And Conditions For IR 25 Week Programmes*
- I have read and accept all the terms & conditions for IR 25 Week Programmes.
What is 1+1?*

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