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APPRENDRE ET VIVRE FULL ONLINE APPLICATION FORM |
Redleaf House, Townspark, Longford,Co Longford
Office Hours: 9.30am to 17.30pm Monday to Friday
info@apprendreetvivre.com
www.apprendreetvivre.com |
| Surname |
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| First Name |
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| Date of Birth |
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Age |
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| Email |
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| Gender |
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Height |
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| Parents Names |
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| Address
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(home) |
| Mobile No. |
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| Country |
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Email |
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| Fathers Occupation |
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Mothers Occupation |
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| Number of Brothers |
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Ages |
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| Number of Sisters |
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Ages |
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| How would you rate your personality |
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How would you rate your level of French/Spanish/German? |
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How long have you been studying the language? |
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| Please tick your favourite activities |
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Tennis |
Cinema |
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Riding |
Rugby |
Museums |
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Swimming |
Reading |
Classical Dancing |
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Computers |
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Theatre |
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Cycling |
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Sailing/WindSurfing |
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| Do You Play any musical Instrument? |
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| Do you Smoke? |
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Do you have any special dietary needs or preference? |
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| Are you allergic to anything? (animals etc...) |
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Do you prefer Accomadation Sharing? |
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| If Yes please specify |
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If Yes please specify (Names etc) |
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| Do you take any medication regularly? |
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| If Yes, what kind and for what purpose? |
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Medical Authoristation |
I, being parent or legal guardian of the above-named applicant do hearby appoint Apprendre Et Vivre, their Irish, French/German/Spanish Associates, or their host family to act an my behalf in authorising emergency medical, dental, surgical or hospitalisation for the above-named applicant during the period of his/her stay. |
| Agree to terms |
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Disagree with terms |
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PROGRAMME APPLICATION |
Redleaf House, Townspark, Longford,Co Longford
info@apprendreetvivre.com
www.apprendreetvivre.com
Office Hours: 9.30am to 17.30pm Monday to Friday
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| Reference |
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| Type of Programme |
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| Dates |
From
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To |
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From
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| All Year Round Programme |
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To |
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From
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| Individual escorted transfers to/from Foreign Airport |
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| Parental Consent |
Student Agreement |
I agree to my son's/daughter's participation in the chosen programme and I accept all financial resposibility should my son/daughter have to be sent home for any reason. |
I will respect my host family and group leaders and participate in the programme to the best of my ability and agree to accept their judgement and decisions should the occasion arise. |
I accept without reservation the conditions stated on Apprendre Et Vivre Website. |
I accept without reservation the conditions stated on Apprendre Et Vivre Website. |
| Signature of Consent |
Yes
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Signature of Agreement |
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Please Confirm that you have the following sent to Apprendre Et Vivre |
Language School Teacher |
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| 3 small photographs via (post) |
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School |
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| €300 Booking Deposit (post) |
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Address |
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| Reference from your Language Teacher via (email) |
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Telephone |
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| Recent School exam Report via (email) |
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Language Teacher's Signature |
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Yes
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