1St Mobility Vitoria-Gasteiz

1st Mobility Vitoria-Gasteiz

December 2017

School year 2017/2018

Personal details

Name and Surname:

Date of birth:

City of birth:

Address:

Height:

Home phone number:

Mobile phone number:

Email address:

(here add two fotos in usual family / friends situations)

How would I describe myself?

I have learned english for _____ years long.

How would you describe yourself?

What type of hobbies do you have?

Personal data about illnesses, healthy problems or any kind of allergies or food intolerances (everybody must explain clearly his / her problems and if they need any type of hospital treatment in case of problems).

Have you got any type of Health insurance? Remember that you only need your European sanity card to travel to Spain. Write, please, the name of the private company and a phone number or contact (only in case of private health insurance).

We use to ask to the parents of our pupils if they give permission to the host families

to take some decisions, like going to a doctor or hospital in case of healthy problems,

in order to solve those ones, and to take the decision that the doctor suggest. If you

agree with that, please, let us know here or explain us the way you want us to act.

Details about family and house / flat facilities (Only if you are receiving a pupils / student from abroad)

Name and surname or Father:

How many brothers or sisters do still live at home:

How old are they?

Have you got pets at home?

Do someone smoke in your house / flat?

Questions of general interests about where I live (Only if you are receiving a pupils / student from abroad).

I live in a (cross out the one where you don’t live in):HouseFlat / Appartment

The student who is travelling to us in the future (Martinica / Apricena / Constanz) will have his/her own private room or will share the room?

Another questions of general interest:

Preferences about the student that I am going to receive in my house / flat (Only if you are receiving a pupils / student from abroad):

Do I prefer a boy or a girl?

There is no way to have a boy / girl in my house / flat? (cross out the one that you can’t have)

DateI agree with the terms of this document (Name of parents)