1. Personal Details

 Family Name    First Name  
 Date of birth  
 Nationality    Gender   Male  Female
 Address  
 Telephone    Fax  
 E-mail    Occupation  
 Passport number  
 How did you hear about Crown?  


2.English course details

 Course  Start Date  No. of weeks
 
 


3.Business/Travel/Hospitality Course details

 Course  
 Start Date  


4.Accommodation & Transfers

What type of accommodation would
you like Crown to arrange?
(please select one box only)
For how many weeks / days?    
Accommodation start date (First Night)      
Accommodation finish date (Last Night)  
Would you prefer a host family with
(please select one box only) 		  Young children
  Older children
  No children
  Retired family
  Doesn't matter about children
Do you smoke?   Yes No
Is it OK for your host family to smoke?   Yes No
Is there any food you cannot eat?   Yes No (If yes, state below)
  
Your interests  
Do you have any other
homestay requirements?		  
Would you like Crown
to arrange insurance for you?		   Yes No
Do you suffer from any medical condition or allergy?   Yes No (If yes, specify below)
 
Do you want Crown to arrange airport transfer (NZD 80.00 each way)?   From airport     Return to airport


5.Declaration

  Please read the enrolment conditions

 
  I understand and accept the enrolment conditions as detailed above