Enrolment Form Step 1 of 250%Your Personal DetailsMaleFemaleGiven Name*Family Name*Nationality*Passport NumberFirst LanguageOccupationDate of Birth* Your Address DetailsStreet AddressAddress Line 2CityPost CodeCountryYour Contact DetailsEmail* Telephone (include prefix)FaxEmergency Contact DetailsContact Name*Contact Telephone (include prefix)*Contact Email* Do you have an Agent?Are you booking Direct or through an Agent?*I do not have an agentI do have an agentIn the second and final step you'll be able to select your courses and accommodationAgent / Retailer Contact DetailsCompany Name*Contact Name*Contact Email* Contact Telephone (include prefix) Which course(s) are you enrolling for?NZ Certificate in English Language (Level 4) General English (Full-Time) General English (Part-Time) IELTS Preparation NZ Certificate in English Language (Level 4) English for Migrants (PELT)General English (Full-Time) | Please select an afternoon class option Communication in English TOEIC Preparation IELTS PreparationPlease select your cambridge exam class options FCE CAEStarting Date Course Length (wks)Your English LevelWhat is your current English Level?BeginnerElementaryPre-IntermediateIntermediateUpper IntermediateMedical & Travel InsuranceInsurance is complusary, would you like us to arrange this for you?*Please arrange insurance for meI will arrange my own insuranceAccommodation PreferencesWould you like Seafield to arrange your accommodation?*YesNoAccommodation Arrival Date Accommodation Departure Date Homestay PreferencesHomestay Type*Half BoardFull BoardRoom TypeSingleDouble/SharedDo you have any disabilities?YesNoDo you have any allergies?YesNoAre there any foods you cannot eat?YesNoPlease provide details about your disabilitiesPlease provide details about your allergiesPlease provide details about the foods you cannot eatDo you smoke?YesNoDo you mind your host family smoking?YesNoWould you like to have pets in your home?YesDon't MindNoWould you like infants/small children in your home?YesDon't MindNoList your hobbies and/or interests. Your host family will be selected to match these as closely as possiblePrivate AccommodationIf organizing your own accommodation, please provide your address and contact numbers in New ZealandIf you do not know your New Zealand address at this stage, please advise us as soon as possibleAirport Pick-up/Drop Off(See our Courses and Fees for pick-up & drop-off pricing)Do you require an Airport Pick-up?YesNoDo you require an Airport Drop-off?YesNoAgreementBy submitting this form you confirm you have read, and agree to abide by, the school’s Conditions of Enrolment. Your enrolment documents will be sent shortly (you will not be asked to pay now).CommentsThis field is for validation purposes and should be left unchanged.