ETC Learning Centre

ETC Learning Centre
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Palmerston North
Wellington
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Enrolment Form

Caregiver Indemnity

Refund Policy

Enrolment

Enrolment Application Forms
Please fill out the appropriate forms below.
The Caregiver Indemnity form is compulsory for students under 18yrs of age. Please print and fax back.

Course Name:
Proposed Arrival Date:
Departure Date:
Total Number of Weeks:	(Minimum 4 Weeks)
Campus Site:	Palmerston North Wellington
Accommodation Details:
Airport Pick-up: (Free pick-up in city of study)	Requested

Personal Details
Family Name:
First Name(s):
Date of Birth:
Sex:	Male Female
Permanent Home Address in Home Country:
Postal Address: (if different from above)
Phone Number:
Fax Number:
Email:

Present Citizenship or Nationality:
Passport Number:
Expiry Date:
Present Occupation:
First Language:
Other Languages:
English Knowledge:
Highest Level of Qualifications:
Year Obtained:

Press the Send button to send your enrolment form:

Homestay Application Form (there is a $NZ150 fee for this service)

Your Name:
Are there any foods that you cannot eat?	Yes No
If yes, please indicate:
Do you have any medical conditions?	Yes No
If yes, please explain your medical conditions and special requirements:
Do you smoke?	Yes No

Are you happy if your host family has:
Young children?	Yes No Not Important
No children?	Yes No Not Important
A cat?	Yes No Not Important
A dog?	Yes No Not Important
Other international students?	Yes No Not Important

Tell us something about yourself. Hobbies, sports, other interests, special requirements, allergies etc:
Are there any questions you would like to ask us?

Thank you, John Brunsden Director ETC Learning Centre

Press the Send button to send your homestay form.