Registration Form
For our language courses summer 2017,
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First and Family name:
(Mr, Mrs, Ms):
Home phone:
Date of birth:
E-mail address:

 For Course in St Raphaël:
I wish to enroll in the course shown below:
 Children's Club under 6 years
 Children's Club between 7 and 9 years
 Children's Club 9 to 12 years, advanced in French
 Student course 13 - 17 years
 Adult summer course 4 hrs/day
 Adult intensive course 6 hrs/day
 Adult high intensive course 8 hrs/day
 Private tutorial from 4 hrs/day
 Seminar for language teachers
My current ability in French is:
 Pure beginner
 Can understand and read simple text
 Can converse and read newspaper text
 Can speak reasonably fluently and read novels
 Fluent in speech and reading ability but need polish

I feel that I need training in:
 Basic French
 French as a spoken language
 French writing and grammar

I wish to attend the session
offered below for:

1 week
 From August 13 - August 20

 2 weeks
 From June 18 - July 02
 From July 02 - July 16
 From July 16 - July 30
 From July 30 - August 13

 3 weeks
 From June 18 - July 09
 From July 09 - July 30
 From July 30 - August 20
4 weeks
 From June 18 - July 16
 From July 032- July 30
 From July 23 - August 20

Previous French education:
I attended____years of French in:
 High School  
 University ... years ago.

In St-Raphaël:
 With French family ½ pension in a shared double room,
     youth/adult course
 With French family ½ pension in a single room,
     youth/adult course
 With French family (breakfast only) single room
 Family Boarding House in St. Raphaël (ages 13-16)
 Family apartment for_______ persons
 Made my own housing arrangement
Hotel Standard:
In St-Raphaël:
 Economy Hôtel Le Prado Saint-Raphël
 Economy Hôtel Le Provençal (old harbor)
 Economy Hôtel Du Soleil (with car)
 First class Hôtel Beauséjour **
     Balcony, sea view, on the beach
 First class Hôtel Flore *** in the old town
 Apt. Hotel Promenade des Bains near the beach
 Apt. Hotel booked by myself

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