Spanish Course Registration - Newbridge - Kildare

Students Name*

First NameLast Name
Date of birth*

DayMonthYear
Day-Month-Year
Payee's Name*

First NameLast Name
Full Irish Address*

Address

Street Address Line 2

Town / CityState / Province

Postal / Zip Code
Contact Number*

Area CodePhone Number
Email for the purpose of invoices*

Confirmation Emailexample@example.com
Please select your course for the options below. Once you have SELECTED your option details such as price, times, dates etc of that particular course will be visable.

If you have any questions please do contact us HERE
Spanish Course Options*

Spanish for Juniors (Elementary)Spanish for Juniors (Intermediate)Spanish for Adults (Beginners)Spanish for Adults (Intermediate)Spanish for Adults (Private)Spanish Junior Cert (Group)Spanish Junior Cert (Private)Spanish Leaving Cert (Group)Spanish Leaving Cert (Private)Diploma in Spanish DELEOther
Spanish Leaving Cert Options

Currently attending TYCurrently attending 5th yearCurrently attending 6th yearOther
Your Nationality*
Spanish, French, German etc.
School currently attending?
Please give name of current school, if you selected grinds.
If there are any medical conditions which you feel we need to be aware of?*

YesNo
If you selected 'YES' to the above medical conditions option above please supply as much information as maybe required here.
I give my full consent to the use of material(s) which may contain images of me or a person(s) for whom I'm responsible in the promotion of Leir, it's academy and business through social media (Facebook, Instagram etc.) including Leirs website(s)*

Yes, I give concentNo, I do not give concent
Submit and Payment
No payment is required now, but please select your payment method from below and an invoice or estimate will be issued prior to the start of your course. Please note payment is required in full before the start of any course, program or class.
Payment method*

Banking On-LineCash paymentCredit Card
Details to make your payment by banking online are:

ACCOUNT NAME: Leir Education Limited

BANK ADDRESS: Kildare Town, Co. Kildare, Rep. Ireland

SORT CODE: 901167

ACCOUNT NO: 60750663

IBAN: IE82BOFI90116760750663

BIC: BOFIIE2DXXX

PLEASE PUT STUDENT'S NAME AS REFERENCE
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Leir Education is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, then you can be assured that it will only be used in accordance with this Privacy Policy.
In line with Data Protection Laws & Recent GDPR regulations in order to submit this form you need to offer specific consent*

Yes
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Submit and Payment