REGISTRATION FORM

Course Information

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Book Purchase
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Course:

  • General English
  • 10
  • 20
  • 30
  • 40
  • One-to-One
General English
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  • University Pathway Program
  • 30
  • 40
University Pathway Program
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  • Junior Camp
  • Winter
  • Summer
Junior Camp
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End Date:
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End Date:
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Weeks of Study:
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Student Information

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Your First Name
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Your Phonenumber
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Your Last Name
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  • - nationality -
  • Afghanistan
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  • Argentina
  • Armenia
  • Australia
  • Austria
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  • Bahrain
  • Bangladesh
  • Barbados
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  • Belgium
  • Belize
  • Benin
  • Bhutan
  • Bolivia (Plurinational State of)
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
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  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cabo Verde
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  • Canada
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo
  • Cook Islands
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czechia
  • Côte d\\\'Ivoire
  • Democratic People\\\'s Republic of Korea
  • Democratic Republic of the Congo
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Eswatini
  • Ethiopia
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  • Fiji
  • Finland
  • France
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  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hungary
  • Iceland
  • India
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  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
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  • Kenya
  • Kiribati
  • Kuwait
  • Kyrgyzstan
  • Lao People\\\'s Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Lithuania
  • Luxembourg
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mexico
  • Micronesia (Federated States of)
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
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  • Netherlands
  • New Zealand
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  • Norway
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  • Palau
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Poland
  • Portugal
  • Qatar
  • Republic of Korea
  • Republic of Moldova
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Tajikistan
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom of Great Britain and Northern Ireland
  • United Republic of Tanzania
  • United States of America
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela (Bolivarian Republic of)
  • Viet Nam
  • Yemen
  • Zambia
  • Zimbabwe
- nationality -
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Home Permanent Address:
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  • - select a country -
  • Afghanistan
  • Albania
  • Algeria
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bhutan
  • Bolivia (Plurinational State of)
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei Darussalam
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cabo Verde
  • Cambodia
  • Cameroon
  • Canada
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo
  • Cook Islands
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czechia
  • Côte d\\\\\\\'Ivoire
  • Democratic People\\\\\\\'s Republic of Korea
  • Democratic Republic of the Congo
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Eswatini
  • Ethiopia
  • Faroe Islands
  • Fiji
  • Finland
  • France
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Greece
  • Grenada
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran (Islamic Republic of)
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Kuwait
  • Kyrgyzstan
  • Lao People\\\\\\\'s Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Lithuania
  • Luxembourg
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mexico
  • Micronesia (Federated States of)
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • North Macedonia
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Poland
  • Portugal
  • Qatar
  • Republic of Korea
  • Republic of Moldova
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Tajikistan
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom of Great Britain and Northern Ireland
  • United Republic of Tanzania
  • United States of America
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela (Bolivarian Republic of)
  • Viet Nam
  • Yemen
  • Zambia
  • Zimbabwe
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Agent Information

Agency:
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Contact Name:
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Phonenumber
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Email Address
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Emergency Contact

First Name
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Relationship:
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Emergency Last Name
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Language Spoken:
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Health Insurance

Do you have medical insurance?
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If the answer is no, will you be purchasing it at The Language Gallery Canada?
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Accommodation

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Check-in Date:
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Weeks of Accommodation:
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Special Requirements?
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Require special diet?
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Allergies?
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Medical Conditions?
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Other
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Airport Transfer

Do you require airport tranfer?
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Please provide flight information

Airline:
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Arrival Date:
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Submitting your Application

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