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STUDENT INFORMATION

EMERGENCY CONTACT or LEGAL GUARDIAN if the student's age is under 18

AGENCY IF APPLICABLE

STATUS IN CANADA

Which visa/permit are you going to apply? Study PermitVisitorWork PermitPR/Citizenship

PROGRAM INFORMATION

Start Date
Total Number of Weeks

Adult English Program (16+)

Lesson Option 20 lessons27 lessons29 lessons31 lessons
Course Option Core EnglishJob ReadinessExpert IELTSAcademic Communication & Presentation
Junior English| Family English 20 lessons27 lessons
High School Preparation 1:1 29 lessons31 lessons
Private Lesson 4 lessons8 lessons

LEVEL OF ENGLISH

BeginnerPre-intermediateIntermediateUpper-intermediateAdvanced
Have you taken IELTS or TOEFL exam? If yes, provide your certificate(s).

AIRPORT TRANSER

Not RequiredPick-upDrop-off
If you arrange airport transfer with CIS, provide your flight detail(s) 2 weeks prior to arrival and/or departure.

MEDICAL INSURANCE INFORMATION

Do you require medical insurance? YesNo
Total Number of Weeks
Start Date
End Date
You must have valid medical insurance while studying in Canada. If you have it, provide it 2 weeks prior to arrival.
Do you smoke? YesNo If yes, you must not smoke inside your accommodation.
If you have any allergies, indicate it.
If you take any medication, indicate it.
If you have any medical issue including physical or mental, indicate it.

ACCOMMODATION

Move-in Date
Move-out Date
Moving in on weekends is recommended (Sat-Sat or Sun-Sun)

HOMESTAY

RoomSingleShared
Bathroom PrivateShared
MealFull-boradHalf-boardNo Meal

CASA TORONTO

Room SingleShared
Bathroom PrivateShared

CYPRESS

Room SingleShared
Bathroom PrivateShared

HOMESTAY PREFERENCES

Pets No preferenceCats and dogs okayCats okayDogs okayI do not like petsI am allergic to pets
Children No preferenceAnother studentTeenagersYoung childrenNo children
Dietary No preferenceVegetarianVegan

STUDENT AGREEMENT AND DECLARATION

I confirm that I can participate in all inside and outside class instruction, project-based learning (PBL), indoor and outdoor activities, excursions, and airport pick-up and drop-off (collectively, the "School Activities") provided and arranged by Connect International School (the “School”) or its employees or contractors, homestay families, ISX tour, or other third-party service providers or representatives.

I acknowledge that such School Activities involve dangers, hazards, or risks, including not limited to potential exposure to virus, illness/sickness, accidents during the School Activities.

I understand that I will be responsible for any cost and expenses incurred by me, the School or its employees or contractors, homestay families, ISX tour, or other third-party service providers or representatives. I hereby waive, release, and agree to indemnify all claims that the School or its employees or contractors, homestay families, ISX tour, or other third-party service providers, representatives or agents have any liability on any basis, whether on contract or otherwise, arising from my participation in the School Activities including damages of any kind and nature whatsoever, except such as result solely from their willful neglect or willful default.

I acknowledge and accept that, during the time my study and participate in the School Activities, I may be photographed or video/audio-taped, and I hereby grant the School unrestricted and non-expiring permission and all rights to use or license such media for any advertising or promotional purposes that CIS may deem appropriate, without any compensation whatsoever. It is my child(ren) and my own responsibility not to be video/audio-taped or photographed if I do not wish to be.

I declare that I will disclose any medical condition that I might contract prior to or during my stay at the School and I agree to disclose any pre-existing medical or health condition that may require ongoing or intermittent medical attention or that may affect my ability to fully participate in the School Activities.

I consent to receive electronic messages from CIS and its affiliates containing news, updates, and promotions. I understand that I can withdraw my consent at any time.

I understand that I could be dismissed under the Dismissal Policy, which are available at http://studyciscanada.com/policies/.
I confirm that I have read, understood, and agree to abide by the terms and conditions of registration including the Tuition Refund Policy and the Dispute Resolution Policy, which are available at http://studyciscanada.com/policies/.
All of the information I have submitted to CIS is accurate and complete. I understand that any false or incomplete information submitted may invalidate my registration.