Application Form

Application Form

Irish Experience registration form
1. Program information (Course selection)
Course choice:*
2. Application information
Full name, exactly as on passport:
Surname:*
First Name*
Middle Name:
Mailing address:*

Street Address

Street Address Line 2

CityProv

Postal CodeCountry
E-mail:*
Cell phone:*

Area CodePhone Number
Country of citizenship:*
Gender:*

MaleFemale
Date of birth:*

MonthDayYear
Place of birth:*
3. Parent/guardian information
First Name:*
Last Name:*
Relation:*

MotherFatherOther
If "other" please specify:
Phone:*

Area CodePhone Number
E-mail*
4. School information
School presently attended:*
Address:*
Most recently completed English course:*
(by June 30, 2025)
Do you have an Individual Plan (IEP)?*

YesNo
5. Additional information
How did you hear about this course?
Special requests (e.g. sharing with another student) or allergy/dietary information:
6. Insurance information:

The TIPS Ultimate Youth Cancellation and Health is included in the program costs
7. Payment Options
Payment Method*

Credit CardCheque or E-Transfer
Pay by Credit Card:

To pay by Credit Card, please submit this form and call Ventresca Travel Ltd. at 416-745-1145 to provide payment details.
Cheque:

Cheques should be made payable to Ventresca Travel Agency Ltd and sent to them at 8-4801 Steeles Ave West, Toronto, ON, M9L 2W1.
Pay by Cheque

I will send a cheque for $1,250.00 upon submitting form
E-Transfer:

All e-transfers to be sent to travel@ventrescatravel.ca with the following information:

Name of Program: The Irish Experience

Name of Parent Guardian submitting payment: First Name and Surname

Name of Student applying: First name and last name (as per their passport)
Should be Empty:

Application Form

1. Program information (Course selection)

2. Application information

3. Parent/guardian information

4. School information

5. Additional information

6. Insurance information:

The TIPS Ultimate Youth Cancellation and Health is included in the program costs

7. Payment Options