Application Form Youth Exchange: Declaration of Consent

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Application form Youth Exchange

Please fill in in block letters.

Surname, first name

Birth date T T . M M . J J J J

Gender female male divers

Guardiance
Surname, first name

Emergency number
(always available)
E-Mail address

For meals No Specifies vegetarian


In case of special requirements,
please specify. No Pork Other

Remarks
Please enter allergies, diseases;
medication or other remarks that we
need to know about
Hobbies
Previous musical experience
Instrument

Declaration of consent
I hereby give my consent for my child to participate in the international youth exchange.
I have read the conditions of participation. Furthermore I agree that images and videos may be created and
published as part of public relations.

Place, Date Signature

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