Clubclass Enrolment Form

Clubclass Enrolment Form
Student Information

The below name and surname will be printed on your End of Course Certificate. The additional information is required to send you your placement test and for communication purposes
Name*

First NameLast Name
Email*
example@example.com
WhatsApp Phone Number*

Country CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

DayMonthYear
Date
Please upload a photo clearly showing your face to be used for identificatory purposes*

Cancelof
Nationality*
Gender*
Passport/Identity Card Details
Passport/ID Card Number*
Country of Issue*
Date of Issue

DayMonthYear
Date
Date of Expiry*

DayMonthYear
Date
Please upload a copy of your Passport/ID Card (front/back)*

Cancelof
Course Details
Do you require course?*
Course start date*

DayMonthYear
Date
Course end date*

DayMonthYear
Date
Course Type*
Accommodation Details
Do you require accommodation*
Accommodation start date*

DayMonthYear
Date
Accommodation End date*

DayMonthYear
Date
Accommodation Type*
Room Type*
Meal Plan*
Do you have any dietary Requirements?*
Please Specify*
Travel Details
Do you require an airport transfer on arrival?*
Do you require an airport transfer on departure?*
Arrival Date

DayMonthYear
Date
Departure Date

DayMonthYear
Date
Please upload a copy of your Flight Tickets

Cancelof
Would you like to book Travel Insurance?*
Emergency Contact
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country CodePhone Number
Relationship to you
Medical Information
Do you suffer from an illness/disability*
Please specify*
Do you have any allergies?*
Please specify*
Payment
Choose a payment option*

Bank TransferFlywirePayPalTransfermate
Do you require the final invoice to be issued in a Company’s name?*

YesNo
Kindly provide your Company’s details below:
Company Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
VAT Number
Contact Person

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Additional comments:
Signature*

Powered by Jotform SignClear
Date of Issue*

DayMonthYear
Date
Should be Empty:

Clubclass Enrolment Form

Student Information

Passport/Identity Card Details

Course Details

Accommodation Details

Travel Details

Emergency Contact

Medical Information

Payment

Kindly provide your Company’s details below: