Application Form:
 
Surname: *  
Name: *  
Date of Birth: *  
Gender:   Male Female  
Nationality: *  
First Language:    
Occupation/Profession:    
Address: *  
Telephone Number:
(Please include country code)
 *  
Mobile Number:
(Please include country code)
 *  
Fax Number:
(Please include country code)
    
E-mail: *  
Verify E-mail: *  

We strongly advise you to take out adequate insurance for
medical costs, accidents, theft, cancellation fees, etc...


In case of Emergencies
Surname: *  
Name: *  
Telephone Number:
(Please include country code)
    
Mobile Number:
(Please include country code)
 *  
Fax Number:
(Please include country code)
    
E-mail: *  
Verify E-mail: *  

How did you learn about Live in Language?    
Type of course chosen:    
Number of lessons per week chosen:  
For how many years have you studied English?    
Your level of English is:    
       
Course Dates:      
Date Starting:    
Date Ending:    
Do you wish to be sent a course report?   Yes No  

 

Accommodation
Please choose your preferred accommodation:    
Please choose your preferred board:    
Do you smoke?   Yes No  
Will you accept a smoking host family?   Yes No  
Are you vegetarian?   Yes No  
Do you mind children in the house?   Yes No  
Do you mind pets in the house?   Yes No  
- Do you have any medical problems?   Yes No  
- Do you have any food allergies?   Yes No  
       
If you answered Yes to one of the last two questions, or would like to add any other important and /or special request, please give further details underneath
 
 
Hobbies/Interests (we try to match you with a teacher or family with similar hobbies/interests)

 

Arrival and Departure Details
Arrival Date: *  
Flight Number: *  
Flight Class:    
From which airport? *  
Time of arrival: *  
Departure Date: *  
Flight Number: *  
To which airport? *  
Time of departure: *  
Do you need airport transfers?
(Available at an extra cost of 20 Euros each way)		    
Do you need Visa assistance?
(Available at an extra cost of 100 Euros)		   Yes No  

Please be sure to read carefully the following Terms and Conditions before you submit your application

1) I fully understand and agree that any failure which I may perceive at the place where the services are supplied must be notified to the supplier of the services and to the organizer or local representative before the end of the stay unless I am not in any position to notify due to circumstances outside my control. In such case, I am obliging myself to notify at the earliest opportunity any such failure. I agree that if this is not done, no claims against Globe Concept Company Limited (hereinafter referred to as Globe Concept) will be considered for any reason whatsoever.

2) In any case of failure to provide a significant portion of the services agreed upon, after having given notice to Globe Concept as specified above, Globe Concept is undertaking to provide prompt assistance to a consumer in difficulty and will make prompt efforts to find appropriate solutions.

3) I understand that Globe Concept considers the choice of family to be more important than a specific town and reserves the right, after due notification before the execution of the contract, to place me in another area if there is no compatible family in the area I have chosen.

4) I agree to pay the full fees before arrival and understand that the fees must be paid in the currency shown in the price sheets.

5) In the event of a cancellation of booking which occurs within the following time periods, I understand that I will be receiving the following proportional refunds:

If the cancellation is effected by the customer and received by the Company;

a) within 24 hours before arrival – No refund shall be provided.
b) within 1 week before arrival – 50% of tuition fee.
c) within 2 weeks before arrival – 60% of tuition fee will be refunded.
d) within 3 weeks before arrival – 75% of tuition fee will be refunded.
e) within 4 weeks before arrival – all tuition fee as well as 50% of any accommodation fees.
f) at any time exceeding 4 weeks before arrival – full refund of tuition and accommodation fees.

Any bank transfer fees or charges in the case of a refund are to be borne by the customer (or the agent).

6) I declare that I am not suffering from any infectious disease, mental or physical handicap unless i have given due and exhaustive notice of my particular circumstances.

7) After having booked and completed all necessary formalities, Globe Concept is granting the consumer the right, if he is prevented from proceeding with the package, to transfer his booking to a person who satisfies all the conditions applicable in the package, provided the consumer gives reasonable notice of his intent to transfer the booking before the specified departure date.

8) Globe Concept shall be liable for the services provided in the package only up to the amount paid on the contract provided that this clause shall not apply in the case of personal injury directly imputable to the organizer.

9) The compensation to which a consumer shall be entitled in the event of non-performance or improper performance of any of the services involved in the package shall be limited in accordance with the International Conventions which govern such services.

10) I accept the prices and conditions on this form.