Registration Form

Learn English Abroad in Canada!

Do you want to learn English abroad? Canada should be at the top of your list! At CLLC in Halifax we offer excellent programs, instructors and a fantastic living environment to practice your new English language skills.

Please fill out the application form below to start you on your exciting way to learn English as a second language in Canada!

Application Form

 Send us the application form below and our admission officer will contact you soon. You can also call us at +902 461 9577 or Fax +902 461 0919.

*	First Name:
*	Last name:
*	E-mail:
	Country:	Afghanistan Albania Algeria AmericanSamoa Andorra Angola Anguilla Antarctica AntiguaandBarbuda Argentina Armenia Aruba AscensionIsland Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia BosniaandHerzegovina Botswana BouvetIsland Brazil BritishIndianOceanTerritory BruneiDarussalam Bulgaria urkinaFaso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Democratic Republic of the Congo Congo Republicof Cook Islands CostaRica IvoryCoast Croatia Cuba Cyprus CzechRepublic Denmark Djibouti Dominica DominicanRepublic EastTimor Timor LesteEcuador Egypt ElSalvador EquatorialGuinea Eritrea Estonia Ethiopia FalklandIsands FaroeIslands Fiji Finland France FrenchGuiana FrenchMetropolitan FrenchPolynesia FrenchSouthernTerritories Gabon Gambia Georgia Germany Ghana Gibraltar reatBritain Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heardand McDonaldIslands HolySee Honduras HongKong Hungary Iceland India Indonesia Iran Iraq Ireland IsleofMan Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Democratic Peoples Rep Korea Republicof Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta arshallIslands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Federal Statesof Moldova Republicof Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands NetherlandsAntilles NewCaledonia NewZealand Nicaragua Niger Nigeria Niue NorfolkIsland NorthernMarianaIslands Norway Oman Pakistan Palau PalestinianNationalAuthority Panama PapuaNewGuinea Paraguay Peru Philippines PitcairnIsland Poland Portugal PuertoRico Qatar ReunionIsland Romania RussianFederation Rwanda SaintKittsandNevis SaintLucia SaintVincentandtheGrenadines Samoa SanMarino SaoTomeandPrncipe SaudiArabia enegal Serbia Seychelles SierraLeone Singapore Slovakia(SlovakRepublic) Slovenia SolomonIslands Somalia SouthAfrica SouthGeorgiaand Spain SriLanka SaintHelena St.PierreandMiquelon Sudan Suriname SvalbardandJanMayenIslands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Tibet Timor Leste Togo Tokelau Tonga TrinidadandTobago Tunisia Turkey Turkmenistan TurksandCaicosIslands Tuvalu Uganda Ukraine UnitedArabEmirates UnitedKingdom UnitedStates U.S.MinorOutlyingIslands Uruguay Uzbekistan Vanuatu VaticanCityState Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S) Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe SouthSandwichIslands
	Telephone:
	Cell Phone:
	Male / Female:	Male Female
	Passport Number:
	Birthdate:
	Home Address:
	City:
	Province / State, Country:
	Postal Code:
	Program Selection:
	Start Date:	November 3-2008 November 10-2008 November 17-2008 November 24-2008 December 1-2008 December 8-2008 December 15-2008 December 22-2008 December 29-2008 January 5-2009 January 12-2009 January 19-2009 January 26-2009 February 2-2009 February 9-2009 February 16-2009 February 23-2009 March 2-2009 March 9-2009 March 16-2009 March 23-2009 March 30-2009 April 6-2009 April 13-2009 April 20-2009 April 27-2009 May 4-2009 May 11-2009 May 18-2009 May 25-2009 June 1-2009 June 8-2009 June 15-2009 June 22-2009 June 29-2009 July 6-2009 July 13-2009 July 20-2009 July 27-2009 August 3-2009 August 10-2009 August 17-2009 August 24-2009 August 31-2009 September 7-2009 September 14-2009 September 21-2009 September 28-2009 October 5-2009 October 12-2009 October 19-2009 October 26-2009
	How Many Weeks:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
	Medical Insurance:	I will purchase Insurance from CLLC I will bring Health Insurance from my home Country
	Do you want a Homestay?:	Yes No
	Do you smoke?:	Yes No
	Do you have allergies?:	Yes No
	Do you take any medications?:	Yes No
	Do you any health problems we should know of?:	Yes No
	If Yes, explain:
	Do you have any special questions or concerns about Homestay?:
	Do you want CLLC Pick Up Service?:
	How will you arrive?:	Airplane Bus Train Car Other
	Arrival Date (if you know):
	Arrival Time:
	Flight Number:
	From What City will you be arriving to Halifax?:
	Other Info about your arrival:
	Did you use and Agent to register at CLLC?:	Yes No
	If Yes, what is the Agency Name?:
	Was this agent helpful and informative?:	Yes No
	Comments about agency?:
Type the keycode in the image into the text box and click Submit to send your request. Enter code:
I have read and accept the CLLC's agreement to all term and conditions which are subject to change at the discretion of CLLC's Please check box to confirm your acceptance and continue