Junior Summer Programme Registration Form

Junior Summer School Galway Registration Form

Personal Details

Lucas
Digne
DD/MM/YYYY
lucasdigne@gmail.com
Please provide a mobile number with international code (+353 86 12345678)

Emergency Contact Information

Martha Digne
Please let us know your relationship to this person ie Grandparent, Guardian etc
marthadigne@gmail.com

Course Details

In exceptional cases we accept mid-week course start dates. Please enter your requested course start date under "other"if this is the case
In exceptional cases we accept mid-week course start dates. Please enter your requested course start date under "other"if this is the case
In exceptional cases we accept mid-week course start dates. Please enter your requested course start date under "other"if this is the case

Accommodation Details

In exceptional cases we accept mid-week arrivals/departures. Please submit your requested dates under "other" if this is the case

Flight Details

Aer Lingus
EI 104 from Milan
Arrival Time
24 Hour Format (Arrival Time = 17.15)
Aer Lingus
EI 106 to Milan
Departure Time
24 Hour Format (Departure Time = 13.30)

Special Requirements

Do you have a special learning requirement? *
I declare that I have read and accept the terms and conditions of registration at Atlantic Language Galway and Dublin. *
Please note that your registration is ONLY PROVISIONAL. An Atlantic Language team member will confirm your registration within two working days of receiving your completed form.