European Exchange Programme 2018 2019 Application Form Name: _________________________________________________Age: ______________________ Date of birth:______________________________________________________________________ Address:__________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Tel(home)_________________________________________________________________________ Contact email address for your family:__________________________________________________ Name of Father:__________________________Tel:(mobile)________________________________ Name of Mother:_________________________ Tel:(mobile)________________________________ Number and age of brothers (if any):___________________________________________________ Number and age of sisters (if any) :___________________________________________________ Mention any additional relevant information regarding family circumstances:__________________ _________________________________________________________________________________ Health Issues (Allergies etc.)__________________________________________________________ __________________________________________________________________________________ Co-Curricular Activities (after school pastimes, interests, hobbies) ___________________________ __________________________________________________________________________________ Do you agree to allow Clongowes permission to circulate your contact details to other families travelling at the same time? Indicate your preference for French or German Exchange :__________________________________ Please indicate your preferred term preferred – in order of choice : 1,2,3 Term One

Term Two

Term Three

Any reasons and other considerations regarding timing:____________________________________ __________________________________________________________________________________ I have read and agree to abide by the guideline for participation in the European Exchange Programme 2017 2017. Parent/Guardian Signature(s): _____________________________Date________________________

Exchange Application.pdf

Page 1 of 1. European Exchange Programme 2018 2019 Application Form. Name: : Date of birth: Address: Tel(home). Contact email address for your family: Name of Father: :(mobile). Name of Mother: Tel:(mobile). Number and age of brothers (if any): Number and age of sisters (if any) : Mention any additional relevant ...

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