Book a Course

To make a booking please fill out the form below.

Personal details

Personal details

Title:

First name:

Family name:

Company name:

House name:

House number:

Street:

City/Town:

Prefecture:

Postcode:

Country:

Contact telephone:

Mobile number:

Email address:

Date of birth:

Native language:

Nationality:

What are your hobbies and interests ?:

Do you have a physical disability that may affect your stay in any way ?:

Yes

Explain your disability:

Do you smoke?:

Yes

Emergency contact

Emergency contact

Name:

Address:

Contact telephone:

Your Course

Your course

Number of hours/lessons per week:

Course name:

Course dates

From:

To:

Activities

1 Activity is equal to 3 lessons

Activities

Number of lessons & activities:

Which activities would you like to do with your teacher?

First choice:

Second choice:

Third choice:

Fourth choice:

Fifth choice:

Sixth choice:

Location & accommodation

Location & Accommodation

I would prefer a teacher in this location

First choice:

Second choice:

Third choice:

I will arrive into this airport/station:

Do you have any allergies ?:

Yes

Explain your allergy:

Your level of English

Your level of English

Do you study English at the moment ?:

Yes

How long have you studied English for ?:

Do you use English in your work ?:

Yes

Please estimate your level of English:

Speaking:

Listening:

Reading:

Writing:

Grammar:

What area of English do you want to develop ?:

Other information:

Arrival & departure

Arrival & Departure

Would you like Homelingua to arrange a driver/taxi to meet you on arrival and/or departure ?: *

arrival only

departure only

arrival & departure

not required

Your travel dates

From:

To:

I have read and understand the Terms and Conditions of bookings: *

Yes