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Registration & Curriculum Form

Please read the frequently asked registration questions article before registering. If you have any questions about the registration, please contact our registrar.

If you would rather download a paper form, fill it out and then mail it to our registrar, please click here. Please note that you must have Adobe reader or other software capable of displaying PDF files in order to use this option.


Name & Contact Information

First Name (*)
Please enter your first name
   
Last Name (*)
Please Enter Your Last Name
   
Street Address or P.O. Box (*)
Please enter a valid street address
   
City (*)
Please enter a valid city name
   
State or Province (*)
Please select your state or province.
   
Zip Code or Postal Code (*)
Please Enter A Valid ZIP Code Or Postal Code
   
Country (*)
Please choose your country
   
Email address for emails from Cwrs Cymraeg
Please Enter A Valid E-Mail Address
If you do not enter an e-mail address, you will not receive a confirmation by e-mail nor will you be enrolled on the cwrs e-mail mailing list.
   
Primary Telephone Number (*)
Please Enter Your Telephone Number
   
Secondary Telephone Number
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Course Residence Information

   
Name As You Want It To Appear On Name Tag And Roster (*)
Please Enter The Name You Want On The Name Tag And Course Roster
   
Residence Type (*)
Please Choose A Residence Type
   
Upgrade To A Single Room (*)
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If There Is Someone With Whom You Wish To Room, Please Give Us Their Name
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Health Information

   
Do You Smoke (*)
Please indicate whether or not you smoke
   
Describe Any Special Needs Or Requirements You May Have.
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Participants May Need To Walk 1-2 Blocks Between Campus Buildings.
   
Please List Any Special Dietary Needs Or Restrictions (e.g., Diabetic, Vegetarian, etc)
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Allergies And Medications (*)


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List Allergies (And Severity), Medications (Dosages), Medical Conditions
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Cymdeithas Madog Fitness Policy

Cymdeithas Madog will do what they can to accommodate the physical limitations of course participants, but we can assume no responsibility in the event that we are unable to do so. Participants must assume the responsibility for determining whether they are physically and medically able to participate. Participants must also assume responsibility for medical conditions that could result in medical emergencies while they are at the course.

After reading the statement above please indicate that you have understood The Cymdeithas Madog Fitness Policy and are physically fit to participate in the cwrs

   
Are You Fit To Attend The Course (*)
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Emergency Contact Information

   
Next Of Kin Or Other Person To Be Contacted In The Event Of An Emergency (*)
Please Enter The Name Of The Person To Contact In An Emergency
   
Relationship To You (Daughter, Friend, etc.)
Please Enter Your Relationship To Your Emergency Contact Person
   
Contact's Primary Telephone Number
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Other Phone Number For Contact
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Contact Person's Address
Please Enter Your Emergency Contact's Address
   
Primary Email Address Of The Contact Person
Please Enter A Valid E-Mail Address
   
Alternate Email Address Of The Contact Person
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Please Give Any Additional Information That May Help Us Contact Or Work With This Person.
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Please Let Us Know The Name(s) Of Anyone Else At This Phone Number That We May Talk To
   
   

Curriculum Information

   
If You Have Attended Cwrs Cymraeg Before, Please List Your Three Most Recent Levels
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Please note that the curriculum has been updated for 2014 and the number of levels reduced from seven to six. It is important that you refer to our guideline of what is taught in each level before choosing the level that is appropriate for you.

Preferred Level (*)
Please enter your preferred level
   
If You Have Not Attended Cwrs Cymraeg Before, Are You A Complete Beginner? (*)
Please let us know if you are a complete beginner.
   
If You Have Not Attended Cwrs Cymraeg Before And Have Some Knowledge Of Welsh, Please Write A Short Paragraph in Welsh
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For example, tell us a little bit about yourself and/or how you came to be interested in Welsh.
   
Additional Information About Your Welsh Language Background That You Would Like To Share With Us
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For example, previous Welsh instruction apart from Cwrs Cymraeg Cymdeithas Madog, or extensive residence in a Welsh-speaking community in Wales, etc.
   
Questions, Concerns, Or Comments About CURRICULUM
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