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Brumun Host Program - guest application
With this form, we collect the data to allow us to seek a host family. You can edit your answers via a link sent to you by email.
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* Indicates required question
Email
*
Your email
Name
*
Please give your name in the form "Surname, Name"
Your answer
Mobile phone number
*
Please enter in the international form +32 120 ..
Your answer
Whatsapp
Please give your Whatsapp number if you with to receive messages over whatsapp
Your answer
Gender
Female
Male
Other:
Clear selection
Age
14
15
16
17
18
Other:
Clear selection
School
The school sending the delegation
Your answer
Guardian's name
*
Indicate the legal guardian, if you have no legal guardien, your primary emergency contact.
Your answer
Guardian's email
Your answer
Guardian's phone
Please enter in the international form +32 120 ..
Your answer
Additional Emergency contact
Indicate any other contacts that could be use in an emergency
Your answer
Your profile
Spoken languages
English
French
German
Other:
Allergies
Please indicate any allergies your hosts shoud take in to acount or that would affect the choice of the host; food, animal .
Your answer
Special Diet
Please indicate if you follow a diet that would affect the choice of the host or set a special requirements for the host family
Your answer
Other conditions
Please indicate if there are any other conditions that would set a special requirements for the host family, e.g. access by wheelchair.
Your answer
Joint application
Let us know if you would prefer to stay close or together with an other guest applying , note this cannot be met in all the cases
Your answer
Arrival
Please indicate the day you would wish to arrive
Mon April 30th
Tue April 31st
Other:
Clear selection
Departure
Please indicate the day you would wish to depart
Fri April 3rd
Sat April 4th
Other:
Clear selection
Comment
Any other comment you may wish to add
Your answer
Consent to share the data
I agree to share my data above with the potential hosts/guests, the organizers and my group leader for the purpose of organizing the host program
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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