Online Registration Form

 

 

 

 

 

 

 

 
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REGISTRATION FORM
Send completed form to : CLC 5460 Yonge St. Suite 301 Toronto, Ont. Canada M2N 6K7 or fax to: (416) 913 8132 tel: (416) 913 8131  email: info@studyclc.com
PERSONAL INFORMATION
Family Name
First Name
Nationality
Native Language
Date of Birth (mm/dd/yyyy)
Gender
Male      Female
Home Address
Zip Code
City
Province/State
Country
Email
Telephone (with area code)
Fax (with area code)
Emergency contact in Canada
Telephone
Emergency Contact in Home Country
Telephone
PROGRAM INFORMATION
Choose your course of study
PT15 (Part-Time Intensive/15 hrs)
SYP (Summer Youth Program)
FT30 (Full-Time Intensive / 30 hrs)
TFL20 (Test of English as Foreign Language / min 4 weeks)
PVT (Private Tutoring / hourly)
BE20 (Business English / min 4 weeks)
Course start date (mm/dd/yy)
Monday:
Course finish date (mm/dd/yy)
Friday:
Number of weeks: 
What is your approximate English level:
Beginner   Intermediate    Advanced
 
 
ACCOMODATION REQUIRED?    yes      no
if yes, please indicate which type of accommodation:
Residence (college Dormitory)
Homestay (stay with a Canadian family)
If homestay, select:
 
* Do you smoke?
Yes   No
* Live with children?
Yes   No
* Live with pets?
Yes   No
* Do you have medical requirements or food restrictions?
Yes   No
if yes, please specify:
WHEN WILL YOU ARRIVE? Please fax a copy of our ticket as soon as you purchase it
Do you require airport pick up?
Yes   No
Arrival Date (mm/dd/yyyy)
Arrival time
Flight number
Name of Airline
Do you require health insurance?
Yes    No
PAYMENT INFORMATION
Registration and other fees (ALL PRICES IN CDN FUNDS)
Registration Fee
$ 100
Airport pick up
$ ($ 90)
Airport return
$ ($150)
Accommodation placement fee
$ 100
Accommodation for weeks
$ (Residence or Homestay fee X number of weeks)
Course fee - Tuition weeks
$ (Program fee X number of weeks)
Private Transportation fee
$ (applies to Summer Youth Program ONLY)
TOTAL PAYMENT
$
SIGNATURE REQUIRED ON THE PAYMENT & REFUND FORM
 
PAYMENT POLICY
Students must pay a minimum deposit of
25% of the total payment fee with a completed registration form
*NOTE: Full payment must be received (by CLC) on or before the first day of classes
 
Payment may be in Canadian or U.S. dollars in the form of International Bank Draft, World Money Order payable to CANADIAN LANGUAGE & LEARNING CENTRE INC. or by Direct Wire Transfer to:
Royal Bank of Canada, 3336 Keele St. North York, On Canada M3J 1L5
BRANCH # 05882 INSTITUTION # 003 CANADIAN DOLLAR ACCOUNT #1011899
BRANCH # 05882 INSTITUTION # 003 U.S. DOLLAR ACCOUNT # 4002903
 
Payments may also be made using a valid credit card.
Check the card you wish to use:
VISA     AMEX    MASTERCARD
Credit card number     Expiry date (mm/yy)
 
 
Cardholder's signature: __________________________________
All payments should be made payable to Canadian Language & Learning Centre Inc. Canadian Language & Learning Centre Inc. assumes no responsibility for any payments made to anyone or any company claiming to represent the school. Canadian Language & Learning Centre Inc. will not be liable in any way to the student for loss, damage, or injury to persons or property however caused.
REFUND POLICY
  1. Non-refundable fees include: Registration fee and Accommodation Placement fee.
  2. Students unable to obtain a VISA are entitled to a full refund of tuition paid (less the non-refundable fees mentioned in section 1.), once the student has returned the original letter of acceptance, with a copy of the rejection letter from Citizenship and Immigration Canada.
  3. Canadian Language & Learning Centre Inc. has the following cancellation policy :
Date of Withdrawal % of tuition refund
30 or more days prior to start date 75 %
0 to 29 days prior to start date 60 %
NOTE:
Any changes to your program enrollment must be made in writing to, Canadian Language & Learning Centre Inc.
  1. Canadian Language & Learning Centre Inc. requires any request for refund where student has registered through an agent, be made through that agent. If student has registered directly through Canadian Language & Learning Centre Inc. an international money order will be issued.
  2. Any accommodation cancellation (minimum of 21 days in advance) is subjected to a $ 150.00charge on used accommodation fees.
  3. A student who wishes to postpone the start date may do so providing they inform the Canadian Language& Learning Centre Inc. in writing at least 4 weeks prior to original start date.
PLEASE READ THE FOLLOWING CAREFULLY:
I, the undersigned wish to register with Canadian Language & Learning Centre Inc. and agree to abide by all the rules and conditions of Canadian Language & Learning Centre Inc.
 
_______________   __________________  _________________  ___ /____/_____
(Student's Signature)    Parent's Signature if student   CLC Representative                  Date
                                      under 18 yrs old
 
SIGNATURE REQUIRED ON THE PAYMENT & REFUND FORM

 

 
Canadian Language Centre 2007