Tuition Hawaii English
Registration Form

ENROLL FOR CLASS HERE.

PART 1 - Personal Information
First & Last Name
Age Male Female
Nationality
City of Birth
Passport Number

PART 2 - Address and Contact Information
Address
Email
Telephone

PART 3 - EMERGENCY Contact Information
First & Last Name
Relationship (Parent, Friend, Sponsor)
Address
Email
Telephone

PART 4 - English Program
Which program are you registering for?
Starting Date
English Level
Which skill do you want to study and improve the most? Speaking & Pronunciation
Grammar & Writing
Reading & Vocabulary
General English - All Skills
Will you be studying English to prepare for an exam?
Yes No
If yes, which exam? CAMBRIDGE
TOEFL
TOEIC
Other
Comments and Questions, Different Starting Dates, Different Number of Weeks

PART 5 - Accommodations and Airport Transfer
Do you need Airport pick-up & transfer to accommodations?
Yes No
Do you want us to find you Accommodations?Yes No
Accommodations
Start Date   (mm/dd/2008)
Number of Weeks
Do you smoke?Yes No
Which kind of accommodation
do you want?		 Private Apartment-condo
Share Apartment-condo
Homestay - Live With Host Family
Residence Hall

PART 6 - Payment Information
I would like to pay by:
Type of Credit Card Visa  MasterCard    JCB
Card Holder Name  
Card Number  
3-digit Verification Code on back of card
Expiration Date //
Promotion Number (optional)

PART 7 - Legal and Medical Information
I will purchase medical insurance prior to starting Hawaii Palms English Program to cover all medical expenses during my stay in Hawaii.   Yes
I will abide by the school rules and policies of Hawaii Palms English School.   Yes
I have read the Cancellation Policy and I agree to the terms in the policy.   Yes
I understand that my registration fee of $100 is not refundable should I decide to cancel my enrollment at Hawaii Palms English School.   Yes
I understand that when Hawaii Palms English School receives this registration form, I will receive confirmation by email and an invoice for my tuition, registration fee, and other fees.   Yes