Exchange Programme registration form

Pupil's surname

First name

Date of birth

Girl or boy Girl or boy Girl Boy

School

School year

School address

Type of school Type of school Private Catholic Public Secular Mixed Other

First language studied

Number of years of study language 1

Language level (C.E.C.R.L.) of the 1st language Language level (C.E.C.R.L.) of the 1st languageA1(beginner)A2(Pre-intermediate)B1(Intermediate)B2(upper Intermediate)C1(Avanced)C2( fluent/ business level)

Second language studied

Number of years of study language 2

Language level (C.E.C.R.L.) of the 2nd language Language level (C.E.C.R.L.) of the 2nd languageA1(débutant)A2(Pre-intermédiaire)B1(Intermédiaire)B2(Intermédiaire avancé)C1(Avancé)C2

Does your child's school accommodate a foreign student for a week? Does your child's school accommodate a foreign student for a week? yes No I don't know

Description of the pupil (is your child shy? Extrovert? Introverted? Studious? Sporty? Sociable? Do they enjoy outdoor activities? Do they like the countryside or the city? their favorite music ?)

Has your child traveled abroad? where ? when?

legal responsible's email

Legal responsible's phone

Mother's surname

Mother's first name

Mother's phone number

Mother's email

Mother's address

Mother's occupation

Father's surname

Father's first name

Father's email

Father's phone number

Father's address

Father's occupation

number of siblings number of siblings 0 1 2 3 4 5

1st sibling's name

1st sibling's age

1st sibling's hobbies

2nd sibling's name

2nd sibling's age

2nd sibling's hobbies

3rd sibling's name

3th sibling's age

3rd sibling's hobbies

4th sibling's name

4th sibling's age

4th sibling's hobbies

5th sibling's name

5th sibling's age

5th sibling's hobbies

Other people living in the house: (grandparent? nourisse? tenant?)

Do you live in a house or apartment? Do you live in a house or apartment?House with gardenHouse without gardenApartmentOther

Do you live in the city or the countryside? Do you live in the city or the countryside? the city the country

The participant The participant will have his/her own bedroom will have his/her own bathroom will share a bedroom will share a bathroom other

How does your child go to school? How does your child go to school? bus walk bike car other

Do you have pets?

More information about the house or family?

Medical or religious regime

Medical treatment

Allergies

Smoking? Smoking? yes no

Your message : Please share any other information you would like to be considered when finding an exchange family

Contracts and consent Contracts and consent I confirm I have read and accepted the Exchange Programme contract I confirm that I have read and accepted the legal notice