Personal Details
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First Name: |
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Last Name: |
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Passport Number / ID: |
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Address: |
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City: |
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Postal Code: |
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State: |
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Country: |
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Tel. |
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Fax: |
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Email: |
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Age: |
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Date of Brith: |
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Gender: |
Male Female |
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Nationality: |
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Father/Guardian: |
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Cell Number : |
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Bussiness Telephone : |
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Mother/Guardian: |
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Cell Number : |
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Bussiness Telephone : |
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Have you ever live traveled away from your family? |
Yes
No |
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Would you describe yourself as: |
Timid Sociable Independent
Athletic Artistic Intellectual
Other:
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List any clubs, organizations or teams you belong to: |
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What kinds of activities do you and your family do together? How often? |
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Health injurance details |
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Make a check by the activities you enjoy: |
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Other information (diets, allergies, health, treatment) |
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Course
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Language you wish to learn : |
Spanish
English |
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Language Level |
Beginner
Elemtary
Intermediate
Advanced
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Type of course |
Half Day
Day Camp
Over Night
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Number of week |
2
3
4
5
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From (dd-mm-yy) : |
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To (dd-mm-yy) : |
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Transfer service
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Transfer service upon arrival : |
Yes
No
From
Flight #
Arrival time
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Transfer service upon departure : |
Yes
No
From
Flight #
Arrival time
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Payment
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250 € deposit
Total Payment
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Methods of payment |
Bank Check
Bank Transfer
Credit Card
VISA
Master Card
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Cancellation Insurance
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If you want to contract the cancellation insurance for Lacunza Summer Camp, with a cost of: |
16 € (less than 500 Euros courses)
24 € (courses between 501 and 1.000 Euros)
35 € (courses between 1.001 and 3.000 Euros)
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How did you find out about Lacunza Summer Camp? |
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Accept the conditions |
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