Buckswood OnLine Booking Form
For payment in €
Available only to residents of EuroZone Countries
Please click here
if you reside outside this Zone
Book a programme at our UK Centres.
Student Details
Surname
Given
Boy/Girl
[Please Select]
boy
girl
Nationality
First Language
Date of Birth
-
1
2
3
4
5
6
7
8
9
0
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Email
(DOB DD-MM-YYYY)
Special Diet requirements?
no
yes
Details
Health Problems
no
yes
Details
Is this the first visit to Buckswood Summer Programmes?
yes
no
How did you hear about Buckswood?
[Please Select]
Friend
Internet
Agent
Other
Details - please give as much information as you can, e.g if you have chosen Internet, please indicate which site
How long have you studied English?
[Please Select]
Never Studied
Less than 1 year
1-3 Years
4-6 Years
More than 6 Years
Parent Details
Surname
Given
Title
Mr
Mrs
Miss
Dr
Profession
Address
Town
State
Zip
Country
Email
International Dialing Code for your Country
Home Phone
Work Phone
Fax
Mobile
Emergency Contact
(recommended)
Name
Phone
Work Phone
Mobile
Email
Country
Buckswood Centres
Please tick a box for each week of your stay. (minimum of 2 weeks)
Jun 29-
Jul 5
Jul 6-
Jul 12
Jul 13-
Jul 19
Jul 20-
Jul 26
Jul 27-
Aug 2
Aug 3-
Aug 9
Plumpton
Jul
9
-
Jul 15
Jul
16
-
Jul 22
Jul
23
-
Jul 29
Jul
30
-
Aug 5
King Edwards - Witley
-
-
Other Services
Airport Transfers
Not Required
Heathrow/Gatwick (incl.)
Stanstead/Luton (€300 return)
Name Tapes
€16 for 36
Yes
No
Optional Extras
Both Centres: Active English;
King Edwards only: ProTennis;
Plumpton only: Horseriding
Please select your first Optional Extra
[Please Select]
ProTennis
Active English
HorseRiding
How many weeks?
[Please Select]
1
2
3
4
Please select your second Optional Extra
[Please Select]
ProTennis
active English
HorseRiding
How many weeks?
[Please Select]
1
2
3
4
Deposit Payment Method
How would you like to pay your deposit?
Credit Card on line
Through your Bank
Credit Card viaFax/Phone