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Registration & Application Form

* Required

Fill up online or Download Application Form

PERSONAL INFORMATION

Gender *
Visa Type *

Please submit copies of these documents upon arrival

Current Address

Emergency Contact Person

Title

STATE OF HEALTH

Illness? Allergies? Medication? Food Exemption?

Additional Services

Student Guard Medical Insurance

Arrival / Departure Information

Airport Reception
Airport Drop-off

Accommodation Information

Homestay
Residence

If Yes, please specify:

Do you smoke?
Do you want to live with smokers?
Do you like pets?
Do you want to live with pets?
Do you like childres?
Do you want to live with children?

(Eurocentres Canada cannot guarantee any of these requests. We will try our best to accommodate your requests.)

English Assessment

Self Assessment

English level will be assessed after your arrival. You may apply for extra English Course in addition to Holiday and Career
Programs.

Program Choices

School Location

General English Courses (Applicants must be 16 years old or older)

Specialized (Elective) Class Add-On (5 lessons per week)

Pathway, University and Career Programs

Holiday & Youth Programs

CONSENT AND ACKNOWLEDGMENT


I hereby register for this program declaring, to the best of my knowledge, that all information on this application form is correct. I will notify
the school immediately in the event of any changes to any of this information. I have read and agree to abide by the school’s Dispute
Resolution, Dismissal and Refund Policies which apply to my program(s) in addition to the Homestay regulations (available upon request) and
all other school Accommodation regulations. I also understand that in the event I am registering through a representative or an educational
agency, they may receive compensation from the school. I understand that Eurocentres Canada assumes no responsibility for any
representations, warranties, or agreements made on its behalf which are not solely contained in printed material produced by Eurocentres
Canada. I understand that Eurocentres Canada collects, retains, and uses personal information in accordance to the Personal Information
Protection and Electronic Documents Act (PIPEDA) and the Eurocentres Canada Personal Information and Privacy Code. I am agreeing to the
collection, retention, and use of my personal information by Eurocentres Canada.

I give Eurocentres Canada permission to release any information regarding my program to my education agent and/or family member. *
I give Citizenship and Immigration Canada permission to release to Eurocentres Canada any information regarding the status of my Visitor Visa and/or Study Permit. *

(By checking No, Eurocentres Canada will not be able to request Visa information on the students behalf.)

I accept the terms of consent and acknowledgment. *

PARENT / LEGAL GUARDIAN CONSENT


This section must be completed by the parent or legal guardian of any student under 18 years of age. The participant agrees to participate
in the entire program and will follow safety instructions and all Eurocentres Canada and Eurocentres Canada Host Family Rules and Regulations.
The participant or legal guardian thereof also authorizes Eurocentres Canada and/or Canada Language Camps and/or the Host Family to attain
medical treatment for the participant in the event it is required and agrees to the decisions and instructions given. It is understood that school
staff and the Host Family are not responsible for any medical instructions, decisions and expenses.

Consent From *
Title *
I accept the terms of consent and acknowledgment. *

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Contact: +1 (604) 688-7942
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