Cours at home

Application form

Billing

First name

Last name

Phone

Address

Postal code

City

The lessons

Lessons address

Postal code

City

Pupil firstname

Pupil lastname

Level

Pupil's date of birth

Subjects (up to 3 choices)

Availabilities

Number of sessions per week

Length of the sessions

Objectives and expectations

Your offer

I accept the cost estimate

An amount of

I wish to pay the rest of the bill:

In case of installment payments, a regulation of 1 to 2 cents in addition to the final bill will be added.

A first payment will be requested to validate the first lesson.

Check this box to accept the general business conditions of Cours at Home By checking the box, I consent to Cours at Home using my data in agreement with the new RGPD regulations (complementary information regarding data protection is listed in our general sales conditions in the Annex of every estimate) I accept to receive the Cours at Home Newsletter

Application form

Billing

The lessons

Your offer

Thanks!