Enrolment Forms

Select one or both of the following:

Send me a free Information Pack
Reserve me a place at Dynaspeak English

Your Details

*Given Name(s):

*Family  Name:

*Your home address:

*Phone:

Mobile number:

*Email address:

Date of Birth:

Sex:   Male Female

Name of School or Employer:

Occupation:

Emergency Contact Details

Name:

Relationship:
Parent Family Member Close Friend Other

Address:

Telephone:

Course Required

Select which course required:
Option 1: Standard Full Time, 25 hours p/w Option 2: Part Time, 10 hours p/w Option 3: FAV25, 25 hours p/w Option 4: FAV35, 35 hours p/w

If none of the courses above, please describe your interests:

Number of weeks:

Preferred start date:

What is your English level?
(1=Beginner, 3=Intermediate, 5=Advanced):
1-5? 1 - Beginner 2 3 - Intermediate 4 5 - Advanced

Accommodation & Medical Insurance

*Do you require accommodation? please choose your preferred option:
Not required Homestay Single Homestay Twin-Share Student Residence Backpacker Hostel

*Do you like pets?   Yes   No

*Do you like children?   Yes   No

Do you have any special needs?
Check all that apply and supply details:
Food   Religious   Medical (including allergies)   Other
Details:

* International students must have appropriate and current medical and travel insurance while studying in New Zealand.

Do you want Dynaspeak to arrange Travel and Medical Insurance?   Yes   No

Airport Pickup

Do you wish to be picked up from the airport?   Yes   No

If yes:

I will supply flight details later

Comments, questions or special requirements...

Confirmation & Payment

Full payment is required in advance. Fees are to be paid in New Zealand dollars. All prices include New Zealand Taxes.

1. On receipt of this Online Application Form your enrolment will be processed and, if accepted, a conditional Offer of Place will be issued.
2. You will receive price, course and accommodation dates and a payment request, together with instructions for payment.
3. Upon receipt of payment a receipt and confirmation of enrolment will be sent to you, and your airport welcome, transfer, insurance and accommodation will be arranged.

Declaration

* I understand that by applying to enter a Dynaspeak English programme I accept and am bound by the Conditions of Enrolment which I have either read or had explained to me, and I agree that during my course I will adhere to regulations established by Dynaspeak English. The information I have provided is correct and complete and I have not withheld any information that could affect my enrolment.

ACCEPT   DO NOT ACCEPT

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