I would like to receive information
for the on-line assessment at the following email address:
I would like to be contacted in
the following language:
French
English
Dutch
German
Spanish
Number
Street
PO Box
Town
Country
Post Code
Home Telephone
Student's Mobile Telephone
Fax
Email
my company
a friend
an advertisement
Internet
a trade fair/event
other
Information about the student's
parents/guardians
Mrs
Mr
First Name
Surname
Mobile telephone
Email
Mrs
Mr
First Name
Surname
Mobile telephone
Email
Information about the student's
school
Name of school
Telephone
Post Code
Town
Country
Information about the stay
Self Assessment: select the option
corresponding to your level
Beginner
Elementary
Intermediate
Advanced
CERAN JUNIORS
BELGIUM
Dates
Centre
Language
Private Lessons (per week)*
from Sunday
/ /2007
CERAN JUNIORS BELGIUM (PRE-TEENS/TEENS/
SENIORS)
French
English
Dutch
German
2
4
2
4
2
4
2
4
to Saturday
/ / 2007
Supplements for transport organised by
the centre
on arrival
on departure
Brussels National Airport
Brussels Centre
Brussels South (Charleroi) Airport
Liege Guillemins Station
Verviers Station
CERAN JUNIORS UK
Dates
Centre
Language
from Sunday
/ /2007
CERAN JUNIORS
UK (TEENS/
SENIORS)
English
to Saturday
/ / 2007
Supplements for transport organised by
the centre
on arrival
on departure
London Heathrow Airport
CERAN JUNIORS
SPAIN
Dates
Centre
Language
Private Lessons (per week)*
from Sunday
/ /2007
CERAN JUNIORS
SPAIN (TEENS/
SENIORS)
Spanish
2
4
to Saturday
/ / 2007
Supplements for transport organised by
the centre
on arrival
on departure
Malaga Airport(included)
* TEENS AND SENIORS only
Obligatory practical information
■ You are required
to take out the necessary health and travel insurance for
your child's stay. EU residents should provide their children
with the European Health Insurance Card.
■ In case of emergency, please
contact the following person:
The parent/guardian of the student, whose full contact details are given
above.
Mrs
Mr
First Name
Surname
Telephone
■ The student's medical
and/or pharmaceutical expenses are payable by you, and will
be deducted from his or her pocket money or, with your agreement,
debited from the credit card, details are given below.
I authorise the CERAN Juniors centre to debit my credit card
to cover the student's medical and/or pharmaceutical expenses.
(details will be requested)
I authorise the CERAN Juniors centre to deduct the student's medical and/or
pharmaceutical expenses from his or her pocket money.
