iTalk English Academy School Registration Form

iTalk English Academy - Cape Town
STUDENT REGISTRATION FORM

Particulars of the pupil
1. PERSONAL DETAILS
Full Name Of Student (as per Passport)

First NameMiddle NameLast Name
Email
Date Of Birth:
Nationality:
Passport Number:
Phone Number ( Whatsapp):
Please enter a valid phone number.Format: (000) 000-0000.
Gender:
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

8. TUITION & FEES
General English
Intensive English
Private Tuition & Exam Prep
- REGESTRATION FEE $45
Payment Method:

Other
9. TERMS & CONDITIONS
- A deposit of $200 or full payment is required to secure your place.

- Full refund (excluding registration fee) if cancelled 21 days before start.

- Placement test must be completed before start date.
10. DECLARATION
Student/Parent (if under 18) Signature
Date:
ADDRESS

50 Long Street, Cape Town Contact Number(s): +971 50 569 0574 / +27 76 979 7062 Email: info@italkenglishacademy.net
Should be Empty: