FORMULARIO DE INSCRIPCIÓN

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1 INFORMACIÓN PERSONAL PERSONAL DATA APELLIDOS / SURNAME MBRE / NAME FECHA DE NACIMIENTO (D/M/A) / BIRTHDATE (D/M/Y) NACIONALIDAD / CITIZENSHIP NÚMERO DE PASAPORTE / PASSPORT NUMBER HOMBRE / MALE MUJER / FEMALE DIRECCIÓN ACTUAL / CURRENT ADDRESS DIRECCIÓN PERMANENTE / PERMANENT ADDRESS TELÉFO / PHONE MÓVIL / CELL PHONE CORREO ELECTRÓNICO / OCUPACIÓN / OCUPPATION

2 CURSO DE ESPAÑOL SPANISH COURSE CURSO / COURSE TYPE NÚMERO DE LECCIONES POR SEMANA / NUMBER OF LESSONS PER WEEK NÚMERO DE SEMANAS / FECHA / DATE OTROS CURSOS OTHER COURSES INTERNSHIP PROGRAMME TRAINING COURSE FOR SPANISH TEACHERS SUMMER JUNIOR PROGRAMME COMMENTS NIVEL DE ESPAÑOL PRESENT LEVEL OF SPANISH LENGUA MATERNA / MOTHER TONGUE NIVEL HABLADO / SPOKEN LEVEL NIVEL ESCRITO / WRITTEN LEVEL

3 ALOJAMIENTO [OPCIONAL] ACCOMMODATION [OPTIONAL] ALOJAMIENTO / ACCOMMODATION FECHAS (DESDE-HASTA) / DATES (FROM-TO) 28 /12 / /12 / TIPO / TYPE SELECCIONE DE LA SIGUIENTE LISTA / SELECT FROM THE FOLLOWING LIST APARTAMENTO PRIVADO / PRIVATE APARTMENT FUMADOR / SMOKER PISO COMPARTIDO / SHARED FLAT FAMILIA DESAYU / MEDIA PENSIÓN / PENSIÓN COMPLETA FAMILY WITH BREAKFAST / HALF-BOARD / FULL-BOARD HOSTAL / HOSTEL HOTEL *** RESIDENCIA DE ESTUDIANTES DE VERA SUMMER STUDENT RESIDENCE ATENCIÓN: LAS HABITACIONES DOBLES SE RESERVARÁN SÓLO PARA PERSONAS QUE VENGAN JUNTAS AL PROGRAMA. LLEGADA: EL DOMINGO ANTES DEL COMIENZO DEL CURSO. SALIDA: EL SÁBADO DESPUÉS DEL PROGRAMA. TE: DOUBLE ROOMS CAN ONLY BE RESERVED FOR PEOPLE COMING TOGETHER FOR THE PROGRAM. ARRIVAL: THE SUNDAY BEFORE THE COURSE BEGINS. DEPARTURE: THE SATURDAY AFTER THE END OF THE COURSE. ALERGIAS / ALLERGIES TIPO / TYPE DIETA ESPECIAL / SPECIAL DIET TRANSFER DEL AEROPUERTO AL ALOJAMIENTO / AIRPORT TRANSFER TO ACCOMMODATION ESTADO DE SALUD STATE OF HEALTH DEBERÁ ENVIAR COPIA DE SU SEGURO MÉDICO / DE ACCIDENTES / VIDA / RESPONSABILIDAD CIVIL QUE CUBRA SU ESTANCIA EN ESPAÑA, O SI LO DESEA TANDEM PUEDE REALIZAR LOS TRÁMITES DEL SEGURO PLEASE SEND A COPY OF VALID HEALTH / ACCIENT / LIFE / CIVIL RESPONSIBILITY COVERING YOUR STAY IN SPAIN, OR IF YOU WISH, TANDEM CAN ORGANIZE YOUR INSURANCE COVEREAGE DESEA QUE TANDEM LE TRAMITE EL SEGURO? / WOULD YOU LIKE TANDEM TO ORGANIZE YOUR INSURANCE COVERAGE?

4 CONDICIONES GENERALES GENERAL CONDITIONS INCLUIDO EN LA MATRÍCULA D E INSCRIPCIÓN / INCLUDED IN THE ENROLMENT FEE (45 ): ADMINISTRATION EXPENSES, EDUCATIONAL MATERIAL (A TEXTBOOK, PHOTOCOPIES). IN THE CASE OF «BILDUNGSURLAUB» WE CHARGE AN ADDITIONAL ADMINISTRATION FEE OF 30. INCLUÍDO EN LA MATRÍCULA DEL CURSO / INCLUDED IN THE COURSE FEE: LEVEL-TESTING, COURSE TUITION, FOLDER WITH INFORMATION ON MADRID, THE COSTS OF SOME OF THE ACTIVITIES IN THE CULTURAL PROGRAM, CERTIFICATE OF ATTENDANCE, LANGUAGE EXCHANGE WHERE APPLICABLE, FREE USE OF LIBRARY AND MULTIMEDIA ROOM, FREE INTERNET ACCESS; FREE ACCESS TO AN ONLINE SPANISH COURSE FOR STUDENTS WHO ENROLL IN A LONG-TERM COURSE. FREE TANDEM-PARTNER (CONVERSATION EXCHANGE UP TO 2 WEEKS). INCLUÍDO EN EL CURSO / T INCLUDED IN THE COURSE FEE: AIRPORT TRANSFER, TRAVEL HEALTH INSURANCE, THE COSTS OF SOME OF THE ACTIVITIES IN THE CULTURAL PROGRAM, FINAL EXAMINATION, DELE EXAMINATION FEES, BILDUNGSURLAUB ADMINISTRATION FEE. INSCRIPCIÓN / ENROLMENT PLEASE SEND YOUR COMPLETED ENROLMENT FORM BY POST, FAX OR . YOU CAN ALSO ENROLL ONLINE USING THE FORM ON OUR WEB PAGE: THE RESERVATION FEE IS 120 AND WILL BE DEDUCTED FROM THE FINAL PRICE (DEPOSIT). UPON RECEIPT OF THE DEPOSIT AND THE ENROLMENT FORM, YOU WILL RECEIVE BY RETURN OUR REGISTRATION CONFIRMATION WITH A DETAILED BREAKDOWN OF THE COURSE AND ACCOMMODATION S FINAL PRICES. FULL PAYMENT INDICATED SHOULD BE MADE BY BANK TRANSFER AT LEAST 2 WEEKS BEFORE THE COURSE STARTS OR IN CASH, IN EUROS ( ), DURING THE FIRST 3 DAYS IN THE SCHOOL. TANDEM RESERVES THE RIGHT TO CANCEL THE ENROLLMENT IF THIS FEE IS T PAID WITHIN THE STIPULATED DEADLINE. THE ACCOMMODATION ADDRESS WILL BE SENT 1 WEEK PRIOR TO ARRIVAL. PAGO / PAYMENT PAYMENTS SHOULD BE MADE TO OUR BANK ACCOUNT IN: BANCO DE SABADELL C/ GRAL. MOSCARDÓ, MADRID BANK 0081, AGENCY 0189, DC 86, ACCOUNT SWIFT BSABESBB IBAN ES ALL BANK CHARGES ARE PAID BY THE SENDER. ALWAYS FAX OR US A COPY OF THE TRANSACTION RECEIPT, (34) PLEASE INCLUDE YOUR NAME AND THE TYPE OF COURSE YOU ARE ATTENDING. THE STUDENT WILL PAY ALL BANK COMMISSIONS CANCELACIÓN / CANCELLATION FEE NUMBER OF STUDENTS PER CLASS: MINIMUM 3; MAXIMUM 10. SHOULD T EUGH STUDENTS ENROL IN A GROUP, TANDEM MADRID RESERVES THE RIGHT TO CANCEL GROUP COURSES UP TO 6 WORKING DAYS PRIOR TO THE COURSE STARTING DATE. IN SUCH CASE A PLACE IN A SMALLER OR INDIVIDUAL CLASS WILL BE OFFERED AND THE TEACHING TIME WILL BE REDUCED TO REFLECT THE GROUP COURSE FEE CHARGED UPON BOOKING. FAILING THIS, THE FULL BOOKING AMOUNT WILL BE REFUNDED. IF YOU CANCEL YOUR PROGRAM, REGARDLESS OF THE DATE PRIOR TO THE START OF THE COURSE, WE HOLD THE RIGHT TO RETAIN 120 EUR OF YOUR DEPOSIT TO COVER ADMINISTRATIVE COSTS. IN THE EVENT THAT YOU HAVE REQUESTED HOUSING, WE HOLD THE RIGHT TO RETAIN 120 EUR TO COVER ADMINISTRATIVE COSTS. CANCELLATIONS WILL BE ACCEPTED UNLESS THEY ARE MADE IN WRITING. DUE TO SECURITY REASONS, ENROLMENTS CAN BE CANCELLED ON THE PHONE

5 CONDICIONES GENERALES GENERAL CONDITIONS INSURANCE ALL STUDENTS IN THE COURSES ARE COVERED BY AN INSURANCE POLICY. TANDEM TAKES RESPONSIBILITY FOR ANY ACCIDENTS THAT MAY OCCUR OUTSIDE OF OUR SCHOOL R FOR THE LOSS OR THEFT OF PERSONAL BELONGINGS ON OUR PREMISES. THEREFORE WE RECOMMEND TO TAKE OUT AN INSURANCE POLICY IN THE COUNTRY OF ORIGIN. VACACIONES / HOLIDAYS CLASSES WHICH FALL ON A HOLIDAY WILL T BE MADE UP ON A FUTURE DATE OR REIMBURSED. CURSOS / COURSES LESSONS LAST 45 MINUTES. NUMBER OF STUDENTS PER CLASS: MINIMUM 3; MAXIMUM 10. SHOULD T EUGH STUDENTS ENROLL IN A GROUP, TANDEM MADRID RESERVES THE RIGHT TO CANCEL GROUP COURSES UP TO 6 WORKING DAYS PRIOR TO THE COURSE STARTING DATE. IN SUCH CASE A PLACE IN A SMALLER OR INDIVIDUAL CLASS WILL BE OFFERED AND THE TEACHING TIME WILL BE REDUCED TO REFLECT THE GROUP COURSE FEE CHARGED UPON BOOKING. FAILING THIS, THE FULL BOOKING AMOUNT WILL BE REFUNDED. CLASSES TAKE PLACE FROM MONDAY TO FRIDAY ALOJAMIENTO / ACCOMMODATION RESERVATION FOR DOUBLE ROOMS ONLY ACCEPTED FOR PEOPLE COMING TOGETHER. ARRIVAL: THE SUNDAY BEFORE THE COURSE BEGINS. DEPARTURE: THE SATURDAY AFTER THE END OF THE COURSE. CONFORME / AGREEMENT LUGAR Y FECHA / PLACE AND DATE FIRMA / SIGNATURE

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