Form

Title

Mr Ms

Full name *

First Name Last Name

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are you...?

a Canadian Resident an international student student living in Canada

Phone Number *

- Area Code Phone Number

Birth Date *

Month Day Year

Gender

Male Female

What languages do you speak? *

Select your country of origin

Emergency Contact *

Full Name

Emergency Contact phone number *

- Area Code Phone Number

Emergency Contact Email *

I want to study *

English (Montreal) French English & French

My language level is *

I want to study in *

Montreal Quebec Both

If you want to study in both cities, select where you want to study first

Montreal Quebec

I want to study for *

I want to register for *

I want to add private lessons to my program *

Yes No

I would like to add.... lessons per week *

Would you like to add them to your whole program?

Yes No

If you answered no to the previous question, for how many weeks would you like to add private lessons to your program?

I want to start my course on *

Month Day Year

If you have taken previous courses of the language you intend to study, please describe

Would you like us to take care of your accommodation? *

Yes No

Select your age range

Under 18 Over 18

Accommodation duration

Accommodation start date

Month Day Year

Accommodation end date

Month Day Year

Type of accommodation

Homestay fullboard Homestay halfboard Roomstay Student residence single room Student residence double room Furnished apartment Studio

Select your accommodation preferences

	Yes	No
Do you have any allergies?
Do you have any illnesses?
Do you take any medication?
Do you eat Red meat?
Do you eat fish?
Do you eat Dairy Products?
Do you eat eggs?
Are you vegetarian?
Could you live in a house with children?
Could you live in a house with dogs?
Could you live in a house with cats?
Do you smoke?

Please note that most families don't allow smoking indoors.

If you have any allergies Please specify

If you have any illnesses Please specify

Interests and comments

Do you require..?

Airport pick up Airport pick up and drop off

Do you require medical insurance

Yes No

How did you hear about us? *

Agency name *

If you selected other, please describe *

I acknowledge having read the cancellation and postponement policy and student expulsion policy *

Yes No

Signature *

Clear

BLI Registration form

Personal Information

Emergency contact

Course Selection

Accommodation

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