Booking Form

Please print out this form, then complete it in BLOCK CAPITALS and return it by fax and then post to:

Oxford House School of English
67 High Street
Wheatley
Oxford OX33 1XT
UK

Fax: +44 (0)1865 873351

1. Personal details

Family name:

Mr/Mrs/Miss/Ms:

First name(s):

Nationality:
Date of birth:

Job/Occupation:

Home address (in your country):

Telephone number:
Fax:
E-mail:


Level of English:*
Box Advanced
Box Intermediate
Box Low Intermediate
Box Elementary

2. Course applied for*

General English
Box Academic Year Course
Box Term/Part-term Course(s)
Box Summer Course(s)
Box Private Tuition



Please specify ..................................
Specialist Courses
Box Combination Course A (standard)
Box Combination Course B (intensive)
Box English Plus (please specify)
Box Individual Specialist Course
Box Closed Group Course (please specify)



Course dates: From .................................. To ..................................

*Please X as applicable

3. Accommodation

Would you like us to find you accommodation? Box Yes Box No

Type of Accommodation:
Box Homestay Family: Single Room
Box Shared Room
Box With private bathroom facilities**

Please specify ..................................

Box Hotel
Box Guest House
Box Other (please specify)

** Please note that these facilities are in short supply and cannot be guaranteed

Do you smoke? Box Yes Box No
Will you bring your car to England? Box Yes Box No

Do you want us to arrange airport collection / transfer at extra cost?  Box Yes Box No

Do you have any health problems or allergies?
Box Yes Box No
If Yes please give details:
Do you have any special dietary requirements?
Box Yes Box No
If Yes please give details:




4. Financial Guarantee

I have read and understand the terms and conditions of enrolment. I accept these terms and conditions and I undertake to pay the balance of the course fees on or before the first day of my course.
Signature of student


............................................. Date.......................................

Name and Address of Next of Kin (Person to contact in an emergency)

Mr/Mrs/Miss/Ms...................................
Address .............................................
.......................................................
Tel. No. .............................................
Mobile No. ..........................................
E-mail................................................

How did you hear about Oxford House?

For details of payment methods please see our terms and conditions.

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