Spanish in Spain Individual Registration

Leir Education & Language Academy Spanish in Spain Individual Registration

Under 18's (Minor) Students Registration Details
Student Information
Students Name*

First NameLast Name
Date of birth*

DayMonthYear
Day-Month-Year
Current School*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Email*
example@example.com
School Phone Number*
Current School Year*
School Contact*

First NameLast Name

Student Identification
Please upload image of Passport or other photo ID*

Cancelof
Passport / ID Number*
Date of issue*

MonthDayYear
Date
Date of expiry*

MonthDayYear
Date
Please upload a recent Photo (Not Passport or ID)*

Cancelof

Parents / Guardians Section
Full Name (Parent / Guardian)*

First NameLast Name
Full Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*

Confirmation Emailexample@example.com
Phone Number*
Please upload photo ID*

e.g. Passport, Driving Licence etc.
Cancelof
Full Name (Parent / Guardian)

First NameLast Name
Full Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email

Confirmation Emailexample@example.com
Phone Number
Please upload photo ID

e.g. Passport, Driving Licence etc.
Cancelof
Please put here any relevant information you feel we need to be aware of while he or she is participating in our program
Are there are any medical conditions or dietary requirements we need to be aware of, on behalf of the student?*

YesNo
If you selected 'YES' to the above medical conditions and or dietary requirement options above please supply as much information as maybe required here.
Any other information which you feel maybe relevant please include here. *
IF NONE.....PLEASE WRITE NONE
I give my full consent to the use of material(s) which may contain images of me or a person(s) for whom I'm responsible in the promotion of Leir, it's academy and business through social media (Facebook, twitter etc.) including their website(s)*

Yes, I give consentNo, I don't give consent

Submit and Reservation Payment
Payments schedule
- A reservation fee is NOT required to accompany this application but will be required to reserve a place. This will be deducted from the remaining balance. (This is non-refundable in the event of cancellation by you)
- The first payment is to equal 25% of the balance, paid no later than 10 days before the due date as shown upon the Invoice.
- The second payment is to equal 25% of the balance, paid no later than 10 days before the due date as shown upon the Invoice.
- The remaining balance must be paid no more than 4 weeks before the departure date.
- A fee of 1.5% will be added to any balance on late payments accumulating weekly on the amount outstanding
- Payments should be made by bank transfer as these will not incur transaction fees.
- A standing order option is also available (please contact us for further details)
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Leir Education is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, then you can be assured that it will only be used in accordance with this Privacy Policy.
In line with Data Protection Laws & Recent GDPR regulations in order to submit this form you need to offer specific consent*

Yes
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Leir Education & Language Academy Spanish in Spain Individual Registration

Student Information

Program & language details

How is your Spanish?

Student Identification

Parents / Guardians Section

Submit and Reservation Payment