HSSC Online Booking Form

Please contact hssconline@harrowschool.org.uk if you have any questions completing this form.

Student Information

First Name*

Family Name*

Known as*

Date of birth (day/month/year)*

Student email address*

Gender*
—Please choose an option—MaleFemale

Nationality on Passport*

First language*

Where will the student be living during their English course? Please put the town/city and the country of residence.*

How long has the student been studying English?*

What is the student’s current level of English (if known)?*
—Please choose an option—I am not sureA2 ElementaryA2/B1 Pre-IntermediateB1 IntermediateB2 Upper IntermediateC1 AdvancedC2 Proficiency

Does the student have any learning difficulties we need to be aware of? (This information will be kept confidential and only passed to the tutor)*

Course Details

Please choose your course.*
—Please choose an option—Two lesson trial: £110Five lessons: £280Ten lessons: £540Twenty lessons: £1080

Please tell us the following information:

Preferred start date for the lessons. Please note, we require a minimum of ten days to set up classes:*

Number of lessons a week:*
—Please choose an option—1 x 45 minutes2 x 45 minutes3 x 45 minutes1 x 90 minutes2 x 90 minutes3 x 90 minutesOther

Preferred days of classes:*

Preferred times for classes (British Time):*

During the period of the course you have requested, are there any dates the student is not available?*

Is the student preparing for any English language exams? Please tell us which one:*

Our lessons usually include English grammar, vocabulary, reading, writing, speaking and pronunciation, and listening. Please tell us if there is anything else or anything specific that you would like the lessons to include:*

Do you have any additional comments?*

Parent/Guardian or Agent

Students age 18-22 can complete this section themselves.

Full Name (and name of Agency if applicable)*

Address*

Email address (this will be used by HSSC Online for correspondence/contact)*

Telephone number*

Relationship to the student*
—Please choose an option—ParentGuardianAgentN/A I am the student

Please read the consent form and click in the box to say that you consent for your child/ward to have online English lessons through Harrow School Short Courses.

Yes, I give my consent

Please read our terms and conditions and click in the box to say that you have read and understood them.

Yes, I have read and understand the terms and conditions.

Important Information:

In order to participate on this course the student will need:

• a computer or large tablet

• a broadband internet connection

• a webcam and headphones

Where did you hear about our online courses?*

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