|
| Surname * |
Name * |
|
|
| Address * |
ZIP Code * |
City * |
Country * |
|
|
|
|
| Birth place * |
Birth date * |
Home phone |
Email * |
|
|
|
|
| Mobile number |
Frequent School Name |
Hear From |
|
|
how did you know about the MB International Summer Camp
|
| PARENT 1: Surname and Name: * |
Mobile phone * |
Email * |
|
|
|
|
| PARENT 2: Surname and Name |
Mobile phone |
Email |
|
|
|
|
| |
| COURSE INFO: |
| Program Selected * |
Preferred Language * |
Language Level * |
Sports * |
|
|
|
|
|
| Weeks |
From |
to |
I wish to stay with |
|
|
|
|
|
| |
| TRAVEL DATA: |
| Arrival at * |
Departure from * |
Travel Notes |
|
|
|
|
|
| PERSONAL INFORMATION: |
| Does the student suffer from particular illnesses, allergies or food problems or take medication regularly? |
|
|
|
| Favorite Hobbies & Sports |
|
|
|
| MB Enrollment Fee |
110,00 € |
| Package Price |
0,00 €
|
| Transfer from airport / station on arrival * |
Yes
No
|
0,00
€
|
| Transfer From airport / station on departure * |
Yes No
|
0,00
€
|
| Cancellation insurance (6% of total) * |
Yes
No
|
|
| Additional medical insurance (45€) * |
Yes
No
|
|
| |
| NB: THE FINAL PRICE, AT THE TIME OF THE BALANCE, CAN BE SUBJECT TO VARIATIONS DUE TO CHANGES IN CURRENCY |
| Deposit amount |
|
| |
| AUTHORIZATION OF PARENTS FOR STUDENTS OF 18 YEARS |
| I declare to have read and approved the information and the general conditions provided by MB * |
Yes
No
|
| I authorize my child to leave the village without supervision (only 16+) * |
Yes No
|
| I authorize the school to provide immediate medical assistance * |
Yes No
|
| |
| I pay the deposit and send a copy of payment by email by * |
| Credit Card or Paypal |
| Bank transfer to: BANCA MONTE DEI PASCHI DI SIENA SPA (IBAN: IT59T0103012190000003141010 BIC: PASCITMMXXX) |
| |
| I confirm to have read and abide to the rules and the information provided by the data protection law D.Lgs. 101 del 10/08/2018 * |
| GIVE YOUR CONSENT TO THE PROCESSING OF PERSONAL AND / OR SENSITIVE DATA NECESSARY FOR THE PERFORMANCE OF THE TRANSACTIONS INDICATED IN THE ABOVE, INCLUDED THE PROMOTIONAL AND ADVERTISING |
| PROVIDE YOUR CONSENT TO THE PROCESSING OF PERSONAL AND / OR SENSITIVE DATA NECESSARY FOR THE PERFORMANCE OF THE TRANSACTIONS INDICATED IN THE ABOVE, EXCLUSION OF THE PROMOTIONAL AND ADVERTISING |
| |
