Student Registration Form

Student Registration Form

3-Week Course: 29th/30th June - 20th/21st July 2024
Name*

First NameLast Name
Please upload a recent headshot photograph*

This photo will be printed on your student ID card. Please no hats or sunglasses.
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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Home

Country CodePhone Number
Student Mobile*

Country CodePhone Number
Mother's Mobile

Country CodePhone Number
Father's Mobile

Country CodePhone Number
Student's Email*
example@example.com
School*
Gender*
Date of Birth*

DayMonthYear
Date
Nationality*
How many siblings (if any) do you have?*
What number are you?*
What level of English (CEFR) are you?*
Please upload any Cambridge English Certificates attained.

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Have you attended a course at Moyle Park before?*
Have you attended an English course in another school/college?*
Year you attended:
Number of weeks:
Country:
Name of college:
Accommodation:
If other please give details:
If you would like to share with a friend, please give your friends name.
Do you have any preferences regarding accommodation?*
If yes, please specify:
We will endeavour to place students according to their preferences where possible.
Do you have any dietary needs?*
If so please specify:

CeliacDairy FreeLactose IntolerantHigh ProteinVeganVegetarianOther
If other please specify:
Do you suffer with any of the following?*

NoAllergiesAsthmaEpilepsyDiabetesEnuresis (bed-wetting)DepressionPanic AttacksAnxietyDyslexiaADD - Attention Deficit DisorderADHD - Attention Deficit Hyperactivity DisorderDyspaxiaAutismTourette SyndromeAny other learning dificultiesAny other physical health conditionsAny other physiological health conditionsOther
Do you take medication and/or follow a specific treatment?
If Yes, please give details.
Do you suffer from any other special needs that your host family and/or teachers should be aware of? If Yes, please give details.
Some medical conditions may incur an extra charge.
Covid-19 Terms and Conditions
- Moyle Park English Language College will follow the Department of Education and Irish Government’s guidelines and advice in relation to Covid-19. Information can be found at the following links:
- https://www.hse.ie/eng/
- https://www.gov.ie/en/
- Moyle Park English Language College will take all precautions necessary to ensure the safety and protection for all in involved in the summer school.
- Everyone’s risk is substantially reduced when all students and group leaders are vaccinated against Covid-19.
- The vaccines currently accepted by Ireland & The European Union are Astra-Zeneca, Pfizer-BioNtech, Moderna & Janssen. If you have received another type of vaccine, a negative PCR Test may be required to enter Ireland. A PCR Test may also be required on departure for students. (Please check relevant travel advice closer to the time).
- In the interest of student welfare and safety, students may be accommodated with other students of their arrival group to minimise and contain and any spread of Covid-19 that may occur. This will be under the discretion of management in Moyle Park.
- Moyle Park English Language College will take every precaution to ensure that an isolated case or a class cluster breakout will be carefully monitored and managed.
- If a host family is unable to host a suspected or positive case of Covid-19, alternative arrangements will immediately put into place by Moyle Park. This may incur a hotel stay which will be the responsibility of the students and their parents or guardian. In this case a group leader must accompany the student and stay in a separate room in the hotel.
- All students must take out full travel insurance that includes COVID-19 cover before departure. Students from EU countries should bring the European Health Insurance Card. The School MUST be notified of any health problems prior to arrival.
- All students must adhere to Irish Covid-19 Guidelines and Restrictions at the current time. Updated information can be found on the following link:
  https://www.gov.ie/en/
Conditions of Acceptance

In the consideration of Moyle Park English Language College accepting the application herewith I/we have completed and signed, I/we agree to the following conditions:
- The booking shall only be made when the fully completed signed Registration Form together with the deposit has reached Moyle Park English Language College. The balance of the fees due must be paid prior to the commencement of the course.
- Students may be accommodated with other students and in some cases sharing a bedroom.
- In the event of a student withdrawing before the completion of a course due to any circumstances, the following shall apply:
  a.      any fees outstanding shall immediately become due and payable;
  b.     no allowance in respect of fees already paid shall be made;
  c.      any costs or expenses incurred (including any transportation costs and costs of any person or persons necessary to accompany the pupil) shall be paid and discharged by the parents/guardian of the pupil.
- Moyle Park English Language College is not liable for any articles, property of a student, lost or mislaid.
- In consideration of the premises herein, the person making this booking hereby indemnifies Moyle Park English Language College against all actions, claims, costs, expenses and damages arising from the misconduct, default or any breach of law whatever on the part of the student.
- It is forbidden for students to go to the city centre in the evening/at night.
  All students must return home by 9.30pm.
- Students must obey the college rules. Consumption of ALCOHOL is strictly forbidden. The use of ILLEGAL DRUGS is strictly forbidden.
- In the event of serious misconduct by a student, (such as, shoplifting, the consumption of alcohol, the misuse of drugs, etc), the school management, in consultation with the group leader and/or agent, reserves the right to impose the ultimate sanction of expelling a student from the college, and return him/her to their country of origin at the expense of his/her parent or guardian with no refund of course fees paid.
Please Tick*

I agree to the Covid-19 Terms & Conditions, I agree to the Conditions of Acceptance, I agree to adhere to any Rules or Restrictions set out by Moyle Park English Language College, I authorise the use of my child's image in cultural and educational activities on the college website www.moyleparkelc.com, social media and promotional material, I declare that I have disclosed all relevant information regarding my child, and that the college and/or agent is not responsible for any issues that I have not divulged.
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Student Registration Form

Some medical conditions may incur an extra charge.