Language Courses

Title First Name * Surname * Date of Birth (Day / Month / Year) * Email Address *

Daytime Phone Number * Evening Phone Number * Town / City * First Line of Address * Postcode *

Do you have a disability, learning difficulty, problems with literacy or numeracy or any special medical circumstances? Yes No

You do not have to disclose this information, however, it will be helpful to the College if you let us know in advance of any support that you may need. Any information will be treated in confidence and in accordance with the College’s Data Protection Policy which is available on our website.

If yes, what form does it take?

How would you like to let us know what you are likely to need to accommodate you on the course with regards to the above? Writing Confidential Phone Call

Please ring 01273 859830 after completing this form.

Please write here

In the event of an emergency a sudden loud alarm will ring and lifts will not be in use. Do you think you will need assistance with being evacuated from the building? Yes No

If Yes, please contact the language.centre@bhasvic.ac.uk as you will need to complete a risk assessment prior to the start date so we can accommodate your needs. Please note that it is your responsibility to get in touch with us regarding this.

Please select a course type you wish to take * Language you wish to study * Course choice *

Do you qualify for any concessions? If yes, please provide proof of status here

Have you done evening language courses at BHASVIC before? Yes No

Where did you FIRST hear about us?

If other, please specify.

Ethnic origin *

This information is sometimes needed by the Dept for Education for monitoring purposes

Data Protection
We store and process your data in accordance with Data Protection legislation, we store it securely, we only ever use it in relation to your studies and we never give it to anyone else inside or outside of the EEA. All students will be supplied with a detailed privacy notice on enrolment at the college (either by email or on paper if you prefer). We will securely dispose of your information within 2 years of you completing the course. Any queries about Data Protection can be directed to the College’s Data Protection Officer at dpo@bhasvic.ac.uk

BHASVIC may take your photograph for promotional purposes for use on the College website, social media, printed publications and similar media. Your photograph may be used for up to 6 years from the date of this form, but will not be used for any purpose other than for marketing. If you do not wish to have your photograph used by the College for marketing purposes, please inform the photographer.

Privacy Notice for Evening Language Students

I have read and understood the Terms and Conditions and Privacy Notice for Evening Language Students and I wish to enrol on the above course. I agree to inform the College if my circumstances change (e.g. change of address, cease to receive benefits, etc.)

Agree * SIGNATURE - Please print name *

Success

Thank you very much for submitting your application to the Language Centre at BHASVIC.

Please proceed to the payment to complete your registration by using one of the payment methods below.

Please note that you will not be registered on the course until you have made the payment and submitted all relevant documentation if you are paying a concessionary fee. We operate on a first come, first served basis so it is important that you complete the registration process as soon as possible.

For reference during payment, your course code is and the fee is

Credit or Debit Card (please use ParentPay)

ParentPay

Personal Details

Additional Support Needs

Course

Other Information

Data Protection

Declaration

Success