Fitxa de PERSONALIA (Belgium – Poland)

Name

Surname

Address

Zip Code

Town

Telephone

Mobile

E-mail

Birthday

Sex
male female 

ID

Father's name

His occupation

Mother's name

Her occupation

Business phone of mother or father:

Name, sex and ages of brothers and/ or sisters:

Have you got pets at home?

How far is your school from home?

How do you go to school?

FOREIGN LANGUAGES FLUENCY

English
French
German

Other languages to specify

My exchange student can be:
 Boy Girl Don't mind

Could you accept two exchange students in your house?
 YES NO
In case you could,
 Boy Girl Don't mind

Do you have any medical problems or allergies, which your host family should know about?

Do you have dietary restrictions: health, religious vegetarian?

Favorite food:

Food you dislike:

Hobbies:

Briefly describe your personality. Are you quiet, outgoing… Tell us something about your characteristics.

Other information which may be helpful in making your trip enjoyable:

Instruccions per omplir la Fitxa

  1. Empleneu la fitxa
  2. Envieu-la
  3. A l’email rebreu la fitxa amb PDF. Imprimiu-ne una còpia
  4. Signeu la còpia (pare / mare o tutor)
  5. Porteu la còpia signada a l’Ana Tomàs o a la secretaria del centre abans del 10 d’octubre 2016

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