Study Portuguese in Brazil
 Enrolment Form

  

Personal Details
 

Mr.

Mrs.
Family name(*):

Address(*):
Private tel(*):

Office tel/fax:
E-mail(*):
Nationality(*): Passport No.(*):
Date of birth(*): Place of birth(*):
Occupation(*):
Languages known:
 
Knowledge of Portuguese:
None A little Average Good Very good
 
Where and for how long have you studied Portuguese?
 
Why are you studying Portuguese?
 
How did you learn about the school?
 
Course Details
I would like to enroll for the following course(s):
 
Course name 1(*): From(*): To(*): No. of Weeks(*):
 
Course name 2: From: To: No. of Weeks:
 
Accommodation
Arrival Day(*): Departure Day(*): Total duration(*):
 
Homestay family:
Bed & Breakfast Half-Board Smoker Non-Smoker
Residence Hotel Youth Hostel    
 
Do you have any allergy or medical condition?
 
Yes No

Specify:

On arrival at It's Cool, you must show that you have medical insurance. It's Cool can arrange medical insurance for you.
 
Arrival in Brazil

Do you whish It's Cool to arrange airport transfer upon arrival?
(One-way transfer US$ 50)
Yes No
 
Flight details:
Arrival Date(*): Flight Number(*): From/City(*):
 
I have read the General Conditions and I accept them.
I authorize It's Cool to take appropriate action in the event of a medical emergency and I understand that I am fully responsible for medical bills incurred.
I certify the information given by me in this application form is accurate and complete.

(*)Required fields
 
  

Rua Doutor Franco da Rocha, 386, Perdizes, São Paulo, SP | Fone: (11) 3672-8511 / 3673-7271