Booking Form - English Language School Dublin

Your Details

Name

First Last

Date of Birth

Gender

Female
Male

Nationality

Passport Number

Required for Non-European citizens.

Email*

Student's Mobile Number

Emergency Contact Number

Course Booking

Course

Start Date (Mondays only)

Enter course start date

Number of Weeks

Estimated Level of English

Our classes start at an Elementary level of English. We do not offer beginner classes. To check your level of English please complete our Online Placement Test.

Arrival Details

(if known)

Arrival Flight Number

Arrival Date

Arrival Time

Departure Flight Number

Departure Date

Departure Time

Airport Transfer required?

Yes (€90 each way)
No

Arrival / Departure / Both?

Accommodation

Accommodation required?

Yes
No

Type of Accommodation

Check-In Date

Preferably Saturday or Sunday before Course start date.

Number of Weeks

Special Diet?

Yes
No

€25 Dietary supplement (e.g. gluten free diet)

If yes, please specify in detail:

Do you smoke?

Yes
No

Allergies, Medical Conditions, Special Educational Needs and/or Additional Needs.

Allergies, Medical Conditions and /or Additional Needs:

Yes
No

Please specify any existing allergies, intolerances, medical conditions and / or special educational needs by downloading and completing our Medical & Special Educational Needs Form.PDF.

Confirmation

I have read and accepted the Terms and Conditions.*

I have read and accepted the information, guidelines and policies outlined in the Student Handbook.*

Stay Connected with Atlas*

We'd love to send you a selection of exciting content, free study resources, exclusive offers and the latest info from Atlas by email. We'll always treat your personal details with utmost care and will never sell them to other companies. See our privacy policy here.

Yes please, I'd like to receive exciting content and offers.
No thanks, I don't want to receive exciting content and offers.

Additional Information

Medical Insurance required?

Only for Non-European citizens.

Any other comments

How did you hear about us?*

Search Engine (Google, Bing, Yahoo, Yandex..)
Google Ads
Facebook / Instagram Ads
Facebook / Instagram Page
Email
Friend