Online Enrolment Form

Evakona Education

New Zealand English Language School | Study English in New Zealand

Excellence in English. Our focus is you!

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Online Enrolment Form

Where did you hear about us?
Please specify:
Agent Employee Name:*
Agency Company Name:
Agent Email Address:*
Phone Number:*
Have you studied at Evakona before?*
- Yes
- No
Your Contact Details (Please use English)
Name:*
First Last
Email Address:*
Student's Email Address:*
Home Address:*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone Number:*
Personal Information (Please use English)
Date of Birth:*
DD slash MM slash YYYY
Gender:*
- Male
- Female
Nationality:*
Occupation/Job:
Passport Number:*
Do you currently hold a New Zealand Visa?
- Yes
- No
What type of Visa will you hold in New Zealand?
What type of Visa do you currently hold?
Other Visa Type:
What is the expiry date of this Visa?
DD slash MM slash YYYY
Emergency Contact (Please use English)
Please provide us with an emergency contact.
This could be an agent, a family member, or friend.
Use AGENT details as your emergency contact?
- Use AGENT details as your emergency contact?
Name:*
Relationship:*
Address:*
Phone Number:*
Email:*
Course Information (Please use English)
Which campus do you wish to study at?
Which course do you require?
Other Courses (if required):
Would you like to include Friday activities with your course?
- Yes
- No
How many weeks do you wish to study?
Course Start:
DD slash MM slash YYYY
Course End:
DD slash MM slash YYYY
Your English Level:
TOEIC/IELTS Score:
Accommodation (Please use English)
Do you require us to arrange accommodation?*
- Homestay
- Backpackers/Motel
- Apartment
- Not Required
First Night:
DD slash MM slash YYYY
Last Night:
DD slash MM slash YYYY
Number of weeks/nights:
Do you smoke?
- Yes
- No
Would you prefer a non-smoking family?
- Yes
- No
- No preference
Would you like to stay with a family with children?
- Yes
- No
- No preference
Would you like to stay with a family with pets?
Are dogs OK?
- Yes
- No
- No preference
Are cats OK?
- Yes
- No
- No preference
Do you have any mental or physical health issues and/or allergies?*
- Yes (please specify)
- No
Please specify any health issues...
Is there any food you cannot eat?*
- Yes (please specify)
- No
Please specify any foods you cannot eat...
Do you have any special circumstances that would make living with a homestay family difficult for you?
- Yes (please specify)
- No
Please specify any special circumstances...
What are your hobbies/interests?
Transport to/from Auckland Airport (Please use English)
Do you require transport from Auckland to your school on ARRIVAL?
- Yes from Auckland Airport
- Yes from Auckland City
- No
- Undecided (To be advised)
Arrival Date:
DD slash MM slash YYYY
Arrival Time:

: Hours

Minutes

AM/PM
Flight Number:
Do you require transport from your school to Auckland on DEPARTURE?
- Yes to Auckland Airport
- Yes to Auckland City
- No
- Undecided (To be advised)
Departure Date:
DD slash MM slash YYYY
Departure Time:

: Hours

Minutes

AM/PM
Flight Number:
Do you require Check-In Assistance during departure?
- Yes
Health and Medical Information (Please use English)
Do you want Evakona to arrange insurance for you?*
- Yes
- No, I have my own insurance
Please advise your insurance policy details:
Insurance Dates:
Do you have any pre-existing medical conditions?
- Yes (please specify)
- No
Please specify any pre-existing medical conditions...
Declaration (Please use English)
Is the student under 18 years old?
- Yes
- No
The following is to be completed by a parent or legal guardian if the student is under 18.
If the student is under 18, please provide legal guardian details:*
Does the student require Unaccompanied Minor Service during flights?
- Yes
I give Evakona Education permission to use photos/videos of me for school promotional material and on social media.*
- Yes
- No
I have read, understand and agree to the Evakona Education Terms & Conditions*
I have read, understand and agree to the Evakona Education Terms & Conditions. *
- Yes

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Evakona Education

WHITIANGA

18 South Highway
Whitianga 3510
New Zealand

PO Box 98,
Whitianga 3542

info@evakona.co.nz
p +64 7 867 1178
f +64 7 867 1175

THAMES

415 Mackay Street,
Thames
New Zealand

PO Box 610,
Thames 3540

info@evakona.co.nz
p +64 7 867 9226
f +64 7 867 9227

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