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First Name:	Last Name:
Born in:	Date of birth:
Nationality:	Pass. N.:
Address:	Post Code:
Town:	State:
Country:	Profession:
Phone::	Mobile Phone:
Contact number of a family member in case of emergency:
Sex: Male Female
E-mail:
Repeat E-mail:
How did you hear about Dante Alighieri school?
Where did you study italian?
Name of your teacher:
What textbook did you use? Have you attended courses with us before? No     Yes Are you traveling:  Choose... Alone With friends In a group Friend’s name / group’s name:
Knowledge of Italian: None Little Medium Good Excellent
I want to take part in the language course for the month of:
LENGTH WITH SPECIAL PRICE 4 Weeks € 1.148 3 Weeks € 1.048 Dates: 2 Weeks € 748 Dates:
ACCOMMODATION Double Room (in apartment with other students) With a student i do not know With my friend Friend's name: Single Room (in apartment with other students): + 9,00 Euro per night. Single Flat for 1 student: + 22,00 Euro per night (kitchen, bath, bedroom). Single Flat for 2 students: + 15,00 Euro per person per night (kitchen, bath, bedroom 2 pax) - Only students travelling together. Friend’s name: Single Flat for 3 students: + 10,00 Euro per person per night (kitchen, bath, single room, bedroom 2 pax) - Only students travelling together. Name of two friends: Hotel 3 : SINGLE EN-SUITE bedroom, accommodation with breakfast: + 25,00 Euro per person per night. Hotel 3 : DOUBLE EN-SUITE bedroom, accommodation with breakfast: + 20 Euro per person per night. I will share the room with: Hotel 4 : SINGLE EN-SUITE bedroom, accommodation with breakfast: + 35 Euro per person per night. Hotel 4 : DOUBLE EN-SUITE bedroom, accommodation with breakfast: + 30 Euro per person per night. I will share the room with:
I enclosed the deposit for registration: Payment of 148 euro by CREDIT CARD/DEBIT CARD: Visa, Mastercard, Diners Bank transfer of 148 Euro: Bank: BPER - Branch: Via Solari, 8 – 60025 Loreto (AN) ITALIA Name: Scuola di Italiano Dante Alighieri - Campus L'Infinito Account number: 000042042276 Codice IBAN: IT 62 Z 05387 37381 000042042276 Codice BIC / SWIFT: BPMOIT22 XXX
Notes:
GENERAL CONDITIONS The registration is confirmed and accommodation is reserved only when the School has received the deposit. The deposit is included in total price. The Student shall at all times be responsible for paying any bank or other charges imposed by the bank. The Student shall not be deemed to have paid the deposit in full until such time as the bank account of the School has been credited with the required amount. Therefore, the cost of the transaction must be added to the amount of the deposit. In case of a payment received with deduction due to any bank charges, the School shall recognize only the amount received. An extra 3% charge is added to payment made by credit or debit card at the School. If cancellation occurs at least 90 days prior to the commencement of the relevant course, deposits are refundable with a 30% deduction to cover administrative costs and bank charges. No refunds will be granted for Students who wish to stop attending the course, for any reason and in any circumstances, after the course has commenced. The cost of accommodation is already included in the fee. Parental consent is required for Students under the age of 18 (eighteen). Insurance: Students are fully responsible for any damage caused to school property or housing. Students are not insured by the School against illness, accidents and theft. EU Citizens are exempt from medical expenses if they carry an E111 form, available on request from their local health authority before departure. Non-EU Students must consult their local authority to find out if they will be insured during their stay abroad.
I declare to be in good physical and mental health and to be able to take part to the activities included in the study-vacation program (lessons, sharing accommodation with other students, trips, excursions, social dinners, etc.) I also declare that I do not suffer from any illnesses or diseases that require special care or assistance.
I hereby declare that I have read and accept the terms and conditions.
I authorize the treatment of my personal data in accordance with Regolamento UE (GDPR 2016/679). (To allow registration on the site, consent to the treatment of personal data is necessary)
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