Contact details Western Cape

Exchange Western Cape - Germany/Bavaria

Please fill in the following basic data form so that we can register your application.
The Information you provide will be used to produce a list of participants and contact details, so please ensure that the information you provide is accurate.
You will receive an e-mail with your entries as confirmation. Please check your SPAM folder.
An application is not a guarantee of participation in the program, but a registration of interest in being matched with a host family.
Entering the following data is therefore not binding for you. You are not entering into any obligation to participate in the program. A commitment is only made after successful placement and your acceptance.
The data is processed in accordance with data protection regulations on this website.

INFORMATION PROVIDED BY THE STUDENT

Title *

Last name student *

First name student *

Middle or other First Name/s of Student – (as shown on passport)

Street and street number *

Postcode *

City *

Landline

Mobile student

E-Mail address student *

Date of birth student *

Nationality student *

CONTACT DETAILS PARENT OR LEGAL GUARDIAN

Last name parent 1 *

First name parent 1 *

Mobile parent 1

Last name parent 2 *

First name parent 2 *

Mobile parent 2

MAIN E-MAIL ADDRESS PARENTS: * Please enter ONLY ONE e-mail address. This address is important for your confirmation e-mail and future contact.

SCHOOL

Name of the school *

Street and street number of the school *

School Postcode *

City of the school *

School Phone Number *

School website *

First and last name of Contact Teacher *

Contact Teacher’s email address *

First and last name of second Contact Teacher, if applicable

E-mail address of second Contact Teacher, if applicable

* Confirmation Datenschutz/data security

I hereby confirm that I have read and accepted the BJR's data protection information.