REGISTRATION FORM

A. PERSONAL INFORMATION Family name: First name: Email: Postal Code: Fathers Full name: Mothers Full name: How did you learn about the camp?
A passport-size photograph is required.

Home address: Sex: Age : English level: Telephone: Mobile:

Male

Female

B. MEDICAL HISTORY Medication taken on a regular basis Please specify: Allergies to medicine / food / insects etc. Please specify: Suffering from any diseases? Do we need to know anything about the case? Please specify: Other Please specify:
A medical certificate of recent vaccination is required.

8-16/07/2013 16-24/07/2013
D. PAYMENT ARRANGEMENTS TOTAL AMOUNT 780,00 Cash Credit Card PayPal E. BANK DETAILS Down payment:

C. PERIODS

Eurobank:

IBAN: GR2002600240000130200356434 IBAN: GR7609631300000000890090378

Post Bank:

The Undersigned ______________________ with passport/ID number ______________ give permission to my son/daughter _____________________________ to join Pantheon Intercultural Summer Camp during the period ________________________. Signature _________________

Special terms of joining Pantheon Intercultural Summer Camp:

Down payment 250, 00 (not refundable).
If the participant cancels: 1 month before the departure date, there is a 100% refund of the rest of the amount, not including the down payment. If the participant cancels: 15 days before the departure date, there is a 50% refund of the rest of the amount, not including the down payment. If the participant cancels: 7 days before the departure date, there is a 20% refund of the rest of the amount, not including the down payment.

Having read the above mentioned special terms of joining Pantheon Intercultural Summer Camp, I fully accept them. Signature ___________________ Date