Registration Form

Location Your stay

Accommodation (Sunday to Saturday)*
London Liverpool Brighton
Do you require accommodation? Yes No
Bournemouth
Cape Town Cyprus Paris
Number of Weeks: 4
Please write your FIRST choice and SECOND choice.
Toronto Calgary Accommodation is subject to availability

Student Details Accomodation type (1st choice): Atlantic Point Single Room
Accomodation type (2nd choice):
Family Name: Oliveira Macaiba
Homestay Board: Bed & Breakfast Half-board
First Name: Victor Henrique
DD: 30 MM: 0
Start Date DD: 07 MM: 05 YYYY: 2023
Date of Birth YYYY: 1993
Male Female
End Date DD: 04 MM: 06 YYYY: 2023
*visit bayswater.ac/accommodation for all options
Nationality: Brazilian
Brazil
What country do you live in?: Other Requirements
First language: Portuguese Do you require shuttle bus service Yes No
Home Address: Rua Padre Nestor de Alençar 5780 (Cyprus only)
Are there any foods you do
not eat? (Please Specify):
Country: Brazil Do you have any Cats Dogs Other
Tel: +55 81 996821717 allergies to animals?
E-mail: victormacaiba@hotmail.com Are you happy to live with a family with Yes No
Additional learning support needs? Yes No young children?
If yes, please: Do you have any medical conditions, Yes No
disabilities or allergies?

Emergency Contact Do you smoke? Yes No

Relationship to Student: Wife - Ane Davino Transfers

Telephone: +55 81 995268125 Do you need an airport transfer? Yes No
Email: Arrival airport: Flight code:
Your Current Level of Level of English/French Arrival time: DD: MM: YYYY:

Beginner Elementary Departure airport: Flight code:

Pre-Intermediate Intermediate Departure time: DD: MM: YYYY:
Upper-Intermediate Advanced
Proficiency
Booking
Use of Representatives
Your course Has a representative helped you Yes No
1st course with this application?
Course Name: General English Standart Company Name: Dreams Intercambios
Start Date DD/MM/YYYY 08/05/2023 End Date DD/MM/YYYY 02/06/2023 Contact Name: Bianca Cavalcanti
Number of weeks (if applicable): 4 How would you like to pay?
2nd course/location Bank Transfer Credit Card Debit Card
Course Name:
Location: Declaration
Start Date DD/MM/YYYY End Date DD/MM/YYYY
I have read and understood the Bayswater Education Terms and Conditions.
Number of weeks (if applicable): I accept them willingly to the exclusion of all other terms and conditions.
Terms and conditions can be found at www.bayswater.ac/terms
Visas
Signed: Assinado de forma digital por Bianca
Do you need to apply for a Student Visa? Yes No Bianca Cavalcanti Cavalcanti
Dados: 2022.09.26 15:55:14 -03'00'
Passport number:
Bayswater Education shall comply with the Data Protection Act.
Expiry Date DD: MM: YYYY:
We will only personal information herein contained for the purpose for
Insurance which it is provided. By submitting this form, you acknowledge that
Bayswater Education will have access to it, and consent to such use.
Do you want Insurance? (UK only) Yes No Bayswater Education reserves the right to use information held herein for its
From: To: internal marketing purposes. If you object to such use please tick here