Enquiry form for individual courses and services

Fill out this form if you would like an individual course or services from Eikholt. We will contact you within 3 weeks to clarify your needs and wishes.

"*" indicates required fields

First name*

Last name*

Date of birth*

Address*

Address Postcode

Phone numbers*

E-mail address*

Do you use assistive technology?

I have a guide dog

I am a spoken language speaker

I am a sign language user

How would you like to be contacted?*

Phone number

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E-mail address

Diets and or allergies

Other possible information

Name

Phone numbers