Student Exchange Form

Photo:
Name:

Surname:

Date of birth:

Place of birth:

Foreign languages:

Address:

Postal code & town:

Telephone number:

Mobile number:

Email:

Father's occupation:

Mother's occupation:

Interests, hobbies, sports:

Spare room availablilty?

Who will the guest share a room with?

Other members of the family:

1. Health condition:
a. special diet:

b. allergies, others:

2. Sex of the quest:

3. Pets:

Which ones?

4. Other personal remarks:

5. Emergency number in case of an accident:
by daytime:

by nighttime:

in the weekends:

Reacties zijn gesloten.