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Search for:
Search for:
Booking form 2026
Maribel
2025-09-10T10:42:09+00:00
"
*
" indicates required fields
1
BOOKING DETAILS
2
PERSONAL DETAILS
3
PARENTAL CONSENT
YOUR COURSE
Arrival Date
06/06/2026 (Sat)
13/06/2026 (Sat)
20/06/2026 (Sat)
27/06/2026 (Sat)
04/07/2026 (Sat)
11/07/2026(Sat)
18/07/2026 (Sat)
25/07/2026 (Sat)
01/08/2026 (Sat)
08/08/2026 (Sat)
15/08/2026 (Sat)
22/08/2026 (Sat)
29/08/2026 (Sat)
05/09/2026 (Sat)
Not on a Saturday
Number of weeks
*
1
2
3
4
Please indicate your arrival date if not a Saturday
Note: Additional charges apply for arrivals and departures outside of Saturdays. Please contact help@country-cousins.com for further information regarding the extra costs
Choose your programme week 1
*
Adventure Sports (3 sessions per week, 2.5 hours each) + 15 hours of English Ages:11-17
Adventure Sports (2 sessions per week, 2.5 hours each) + 18 hours of English Ages:11-17
Ball Sports (3 sessions per week, 2.5 hours each) + 15 hours of English
Ball Sports (2 sessions per week, 2.5 hours each) + 18 hours of English
Beach Volleyball (9 hrs/week 3 sessions) + 15 hours of English
Exploring Devon (9 hrs/week 3 sessions) + 15 hours of English Ages: 11 - 17
Exploring Devon (6 hrs/week 2 sessions) + 18 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 15 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Sea Water Sports (9 hrs in 3 sessions) + 15 hours of English
Sea Water Sports (6 hrs in 2 sessions) + 18 hours of English
Sports Science (7.5 hrs / 3 sessions) + 15 hours of English
Street Dance (7.5 hrs/week in 3 sessions) (ONLY FROM 29th June to 3rd August)
Surfing (9 hrs per week) + 15 hours of English Ages: 11 - 17
Surfing (6 hrs per week) + 18 hours of English Ages: 11 - 17
Tennis (7.5 hours per week in 3 sessions) + 15 hours of English Ages: 11 - 17
Tennis (4.5 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Mini Learner Adventure Sports ( 6 to 10 years old)
Mini Learner Exploring Devon ( 6 to 10 years old)
Mini Learner Horse Riding ( 6 to 10 years old)
Mini Learner Surfing ( 6 to 10 years old)
Mini Learner Tennis ( 6 to 10 years old)
Choose your programme week 2
*
Adventure Sports (3 sessions per week, 2.5 hours each) + 15 hours of English Ages:11-17
Adventure Sports (2 sessions per week, 2.5 hours each) + 18 hours of English Ages:11-17
Ball Sports (3 sessions per week, 2.5 hours each) + 15 hours of English
Ball Sports (2 sessions per week, 2.5 hours each) + 18 hours of English
Beach Volleyball (9 hrs/week 3 sessions) + 15 hours of English
Exploring Devon (9 hrs/week 3 sessions) + 15 hours of English Ages: 11 - 17
Exploring Devon (6 hrs/week 2 sessions) + 18 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 15 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Sea Water Sports (9 hrs in 3 sessions) + 15 hours of English
Sea Water Sports (6 hrs in 2 sessions) + 18 hours of English
Sports Science (7.5 hrs / 3 sessions) + 15 hours of English
Street Dance (7.5 hrs/week in 3 sessions) (ONLY FROM 29th June to 3rd August)
Surfing (9 hrs per week) + 15 hours of English Ages: 11 - 17
Surfing (6 hrs per week) + 18 hours of English Ages: 11 - 17
Tennis (7.5 hours per week in 3 sessions) + 15 hours of English Ages: 11 - 17
Tennis (4.5 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Mini Learner Adventure Sports ( 6 to 10 years old)
Mini Learner Exploring Devon ( 6 to 10 years old)
Mini Learner Horse Riding ( 6 to 10 years old)
Mini Learner Surfing ( 6 to 10 years old)
Mini Learner Tennis ( 6 to 10 years old)
Choose your programme week 3
*
Adventure Sports (3 sessions per week, 2.5 hours each) + 15 hours of English Ages:11-17
Adventure Sports (2 sessions per week, 2.5 hours each) + 18 hours of English Ages:11-17
Ball Sports (3 sessions per week, 2.5 hours each) + 15 hours of English
Ball Sports (2 sessions per week, 2.5 hours each) + 18 hours of English
Beach Volleyball (9 hrs/week 3 sessions) + 15 hours of English
Exploring Devon (9 hrs/week 3 sessions) + 15 hours of English Ages: 11 - 17
Exploring Devon (6 hrs/week 2 sessions) + 18 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 15 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Sea Water Sports (9 hrs in 3 sessions) + 15 hours of English
Sea Water Sports (6 hrs in 2 sessions) + 18 hours of English
Sports Science (7.5 hrs / 3 sessions) + 15 hours of English
Street Dance (7.5 hrs/week in 3 sessions) (ONLY FROM 29th June to 3rd August)
Surfing (9 hrs per week) + 15 hours of English Ages: 11 - 17
Surfing (6 hrs per week) + 18 hours of English Ages: 11 - 17
Tennis (7.5 hours per week in 3 sessions) + 15 hours of English Ages: 11 - 17
Tennis (4.5 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Mini Learner Adventure Sports ( 6 to 10 years old)
Mini Learner Exploring Devon ( 6 to 10 years old)
Mini Learner Horse Riding ( 6 to 10 years old)
Mini Learner Surfing ( 6 to 10 years old)
Mini Learner Tennis ( 6 to 10 years old)
Choose your programme week 4
*
Adventure Sports (3 sessions per week, 2.5 hours each) + 15 hours of English Ages:11-17
Adventure Sports (2 sessions per week, 2.5 hours each) + 18 hours of English Ages:11-17
Ball Sports (3 sessions per week, 2.5 hours each) + 15 hours of English
Ball Sports (2 sessions per week, 2.5 hours each) + 18 hours of English
Beach Volleyball (9 hrs/week 3 sessions) + 15 hours of English
Exploring Devon (9 hrs/week 3 sessions) + 15 hours of English Ages: 11 - 17
Exploring Devon (6 hrs/week 2 sessions) + 18 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 15 hours of English Ages: 11 - 17
Horse Riding (8 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Sea Water Sports (9 hrs in 3 sessions) + 15 hours of English
Sea Water Sports (6 hrs in 2 sessions) + 18 hours of English
Sports Science (7.5 hrs / 3 sessions) + 15 hours of English
Street Dance (7.5 hrs/week in 3 sessions) (ONLY FROM 29th June to 3rd August)
Surfing (9 hrs per week) + 15 hours of English Ages: 11 - 17
Surfing (6 hrs per week) + 18 hours of English Ages: 11 - 17
Tennis (7.5 hours per week in 3 sessions) + 15 hours of English Ages: 11 - 17
Tennis (4.5 hours per week in 2 sessions) + 18 hours of English Ages: 11 - 17
Mini Learner Adventure Sports ( 6 to 10 years old)
Mini Learner Exploring Devon ( 6 to 10 years old)
Mini Learner Horse Riding ( 6 to 10 years old)
Mini Learner Surfing ( 6 to 10 years old)
Mini Learner Tennis ( 6 to 10 years old)
Do you have a promotion Code or Agency name?
Promotion Code
Agency or Agent name
Promotion Code
Please note: This code will be applied in your invoice.
Agent or Agency name
YOUR ACCOMMODATION
Accommodation type
*
Homestay
Homestay (dietary supplement) (this will be £8 per day extra on your final bill)
No accommodation required
Arrival day
*
Saturday before start course
Transfer from/to Airport
*
Yes I need transfer both ways
I only need one way
I have arranged private transfer
Your booking total
The above is a summary of your booking information and current booking availability. Please review these details to ensure they are correct before moving onto the next step.
STUDENT DETAILS
Name
*
First
Last
Male / Female
*
Male
Female
Telephone
*
Email
*
Other information
Date of birth
*
DD slash MM slash YYYY
Nationality
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
English level
*
A1 - Elementary
A2 - Pre-Intermediate
B1 - Intermediate
B2 - Upper intermediate
C1 - Advanced
C2 - Proficiency
Don't know
MEDICAL AND DIETARY INFORMATION
Has the student been fully vaccinated for Covid-19?
*
Yes
No
Please indicate the date of the last vaccination
*
Does the student have any allergies?
*
Yes
No
Please indicate what type of allergies
*
Does the Student have any dietary requirements?
*
Yes
No
Please indicate what type of diet requirements
*
Vegetarian
Vegan
Gluten free
Lactose free
No red meat
No pork
No fish
Please not that extra cost will be applied in your invoice for dietary requirements.
Does the Student have any medical condition or physical/mental disability?
*
Yes
No
Please give details
*
E.g. visual impairment, hearing impairment, asthma, fainting, headaches, bed wetting, incontinence,...
Is the Student taking any medication?
*
Yes
No
Please give details, including medication name, dose, how often and when it is taken.
*
WELFARE INFORMATION
Does the Student need any help with mobility?
*
Yes
No
Please give details.
*
Does the Student need any help with social interaction, for example, is the student shy? Is it difficult for him/her to make friends?
*
Yes
No
Does the Student need any support in the classroom?
*
Yes
No
If yes, please give details
*
E.g. is the Student dyslexic?
PARENT/GUARDIAN CONTACT DETAILS
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Home telephone
Work telephone father
Work telephone mother
Mobile father
*
Mobile mother
*
Student's mobile
*
Please note: we will add this number to a whatsapp group for communications during your stay here only
Does the parent/guardian named above speak some English?
*
Yes
No
Phone of the person who can speak English
*
Please indicate the number of the person who can speak English in case of an emergency
MEDICAL
Medical consent
*
I agree to Country Cousins staff giving the Student common, non-prescribed medicine, i.e. paracetamol, cough syrup, ibuprophen in case of sickness.
Medical consent
*
I agree to Country Cousins staff giving the Student controlled medicines prescribed by a doctor in the Student's country or in England.
*
Medical consent
*
I give permission for Country Cousins staff, in an emergency, to follow the advice of attending medical staff and to authorise medical treatment and/or anaesthetic for the Student.
*
PUBLICITY
Country Cousins takes photographs and videos of individuals and groups of students for use in its publicity material and in social media (Facebook and Instagram mainly). Please tick the boxes below if you are willing for the Student to be included in such group photographs/videos.
I consent to photographs being taken of my son/daughter and used in publicity materials, either individually or as part of a group
*
Yes
No
I consent to videos being taken of my son/daughter and used in publicity materials, either individually or as part of a group
*
Yes
No
I consent to photos/videos being taken of my son/daughter and used on social media platforms, such as Instagram and Facebook
*
Yes
No
TRAVEL
Students will be met and collected from the airport/train station by trained Country Cousins ‘Meet & Greet personnel’ who will be waiting at the Arrivals hall. The student will be accompanied by Country Cousins staff to Country Cousins Devon to begin the course.
I agree for the care arrangements for my child’s travel to, reception and care while in the United Kingdom and confirm that my child has my consent to live and travel independently
*
Yes
No
ADDITIONAL FREEDOM
Country Cousins has curfew times according to the age of students. Students are supervised during the day whilst in lessons and on activities. There are times where the students have additional freedom, for example walking to/from school -home, or meeting up friends on weekends and evenings. For children 11 to 15 years old we will presume they may have additional freedom. Please tick the boxes below accordingly.
I agree with the levels of supervision offered to students at Country Cousins and I am aware on additional freedom around town or with staff members at limited times. http://www.country-cousins.com/about-us/policies
*
Yes
No
The following times indicate when students needs to be back in their accommodation. Up to 10 years old: evening activities only 11 & 12 years old: 9pm 13 & 14 years old: 9.30pm 15 & 16 years old: 10.00pm 17 years old: 10.30pm
DECLARATION
You must sign and agree before submitting this booking form.
Agreement
*
I confirm that all the information I have provided is correct to the best of my knowledge.
Agreement
*
I confirm that I accept the terms and conditions of enrolment. (please visit www.country-cousins/terms)
Agreement
*
I agree with and Country Cousins Discipline & Exclusion Policy.
http://www.country-cousins.com/about-us/policies I will help Country Cousins to ensure that my son/daughter respects the rules of Country Cousins and homestay.
Name
*
First
Last
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