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Registration Form

Last Name: *

Firstname: *

Nationality: *

First language: *

Birthday:

Passportnumber:

Sex:

female

male

Occupation:

How did you hear of Rocío Language Classes?:

Home Address:

Telephone:

E-mail:

Address in Arequipa:

Telephone:

Name of employer,school or university:

Address of employer,school or university:

Do you speak another language?:

Yes

No

If yes Which?:

What is your present level of Spanish?:

Beginner

Elementary

lower

upper

advanced

Where do you learn spanish?:

How long?:

Number of weeks required:

Course start date:

Course finishing date:

Do you want One-to- One lessons?:

Yes

No

If yes, how many hours per week?:

At which time?:

Do you wish RLC to arrange accommodation for you?:

Yes

No

Peruvian familie:

Yes

No

Food:

2 Two meals(breakfast/dinner)

3 Three meals (b/d/l)

Hostal / hotel:

Simple room

Double room

private bath

shared bath

Number of weeks:

Arrival date:

Departure date:

Do you smoke?:

Yes

No

Do you have any allergies?:

Yes

No

if yes, please state: :

Are you vegetarian?:

Yes

No

Do you object to dogs?:

Yes

No

Do you object to cats?:

Yes

No

Do you require an airport transfer?:

Yes

No

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Dirección: Ayacucho No. 208 OF 22 - Cercado Arequipa - Perú
Teléfonos: -51-54-224568 / -51-54-286929 / -51-54-959694582
E-mail:info@spanish-peru.com
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