Beispiel eines Fragebogens einer britischen Schule


N.N. COLLEGE


A. FRENCH / GERMAN EXCHANGE PARTNER DETAILS

Please fill in this form carefully with your parents, giving as much information as possible.

Pupil's Surname ______________________

Forenames __________________________

Year Group ________      Height _________ cm     Date of Birth _______________

Occupation of Father _______________________

Occupation of Mother ______________________

Sisters (ages) _____________________ Brothers (ages) ______________________

Address ____________________________________________________________

Description of home (eg house, flat, farm) ___________________________________

Pets at home _________________________________________________________

Telephone No. (with dialling code) ___________________________

Hobbies & Interests ___________________________________________________

___________________________________________________________________

Other relevant information which may help to find a suitable partner for your daughter / son.
PARENTS SHOULD COMPLETE THIS SECTION WITH THEIR DAUGHTER / SON GIVING A SUMMARY OF HER / HIS CHARACTER AND TEMPERAMENT.

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

I want to take part in this exchange because __________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Special problems which should be known by the party leader (eg current medical problems, allergies to food / animals, cigarette smoke etc, special dietary requirements including specific vegetarian needs)

___________________________________________________________________

___________________________________________________________________

Do you have a partner (Name .............) from a previous school exchange visit?   Yes/No

If so, do you wish to be partnered with her / him again?    Yes/No


B. ACCOMMODATION

Would you be prepared to welcome either a boy or girl as your child's partner as the number of boys and girls may not correspond exactly?
WE NEED A PARENTAL SIGNATURE IN ONE OF THE BOXES BELOW. Please be as flexible as possible.

We can accommodate EITHER A BOY OR GIRL / We can accommodate ONLY A BOY / We can accommodate ONLY A GIRL


C. MEDICAL DETAILS

Name(s) of Parent(s)/Guardian(s) _________________________________________

___________________________________________________________________

Daytime contact number (with dialling code) _________________________________

Name and address of family doctor ________________________________________

___________________________________________________________________

Doctor's telephone number (with code) _____________________________________

Relevant medical history ________________________________________________

___________________________________________________________________


D. * I consent to my daughter / son ________________________________________
receiving emergency medical treatment whilst she / he is in France / Germany with the N.N. College Exchange.

French translation

Si l'état de votre enfant nécessite une intervention chirurgicale, donnez-vous l'autorisation de procéder à cette intervention? Oui / Non

German Translation

Ich bin damit einverstanden, dass meine Tochter / mein Sohn während des Aufenthaltes in Deutschland medizinische Hilfe sowie falls nötig chirurgische Behandlung erhalten darf. Ja / Nein

Signed _____________________________________ (Parent / Guardian)

Date _________________________________


E. PASSPORT

Please tick ONE box below:

1.My daughter / son will be travelling on an individual passport.

Number of Passport ___________________________________________

OR

Nationality of her / his passport ______________________________

Issued at ________________________ Expiry date __________________

2. My daughter / son will need to be included in the collective passport.

Town of birth ________________________________________________

Country of birth __________________ Date of birth __ _______________

If your child was born outside the U.K., please complete the following:

Father's full name _____________________________________________

Father's date of birth __________ Father's place of birth __________________

Number of father's passport ______________________

Place of issue __________________ Date of issue ___________________


F. CONDUCT

I / we agree that if, in the unlikely event that my / our daughter / son commits any illegal act or behaves irresponsibly whilst abroad with the exchange group, I / we are liable for the full costs incurred as a result of this, including, where deemed appropriate by the group leader, the cost of transporting and accompanying my / our child back to England prior to the group's return.

Signed _______________________________ Date _________________

PLEASE RETURN THIS FORM AS SOON AS POSSIBLE WITH ALL DETAILS COMPLETED IN FULL WITH PASSPORT PHOTOS WITH YOUR NAME ON THE BACK.



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