Beispiel eines Fragebogens einer britischen Schule
N.N. COLLEGE
A. FRENCH / GERMAN EXCHANGE PARTNER DETAILS
Please fill in this form carefully with your parents, giving as much information
as possible.
Pupil's Surname ______________________
Forenames __________________________
Year Group ________ Height _________ cm Date
of Birth _______________
Occupation of Father _______________________
Occupation of Mother ______________________
Sisters (ages) _____________________ Brothers (ages) ______________________
Address ____________________________________________________________
Description of home (eg house, flat, farm) ___________________________________
Pets at home _________________________________________________________
Telephone No. (with dialling code) ___________________________
Hobbies & Interests ___________________________________________________
___________________________________________________________________
Other relevant information which may help to find a suitable partner for your
daughter / son.
PARENTS SHOULD COMPLETE THIS SECTION WITH THEIR DAUGHTER / SON GIVING A SUMMARY
OF HER / HIS CHARACTER AND TEMPERAMENT.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
I want to take part in this exchange because __________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Special problems which should be known by the party leader (eg current medical
problems, allergies to food / animals, cigarette smoke etc, special dietary requirements
including specific vegetarian needs)
___________________________________________________________________
___________________________________________________________________
Do you have a partner (Name .............) from a previous school exchange visit? Yes/No
If so, do you wish to be partnered with her / him again? Yes/No
B. ACCOMMODATION
Would you be prepared to welcome either a boy or girl as your child's partner
as the number of boys and girls may not correspond exactly?
WE NEED A PARENTAL SIGNATURE IN ONE OF THE BOXES BELOW. Please be as flexible
as possible.
We can accommodate EITHER A BOY OR GIRL / We can accommodate ONLY A BOY / We can
accommodate ONLY A GIRL
C. MEDICAL DETAILS
Name(s) of Parent(s)/Guardian(s) _________________________________________
___________________________________________________________________
Daytime contact number (with dialling code) _________________________________
Name and address of family doctor ________________________________________
___________________________________________________________________
Doctor's telephone number (with code) _____________________________________
Relevant medical history ________________________________________________
___________________________________________________________________
D. * I consent to my daughter / son ________________________________________
receiving emergency medical treatment whilst she / he is in France / Germany with
the N.N. College Exchange.
French translation
Si l'état de votre enfant nécessite une intervention chirurgicale,
donnez-vous l'autorisation de procéder à cette intervention? Oui
/ Non
German Translation
Ich bin damit einverstanden, dass meine Tochter / mein Sohn während des Aufenthaltes
in Deutschland medizinische Hilfe sowie falls nötig chirurgische Behandlung
erhalten darf. Ja / Nein
Signed _____________________________________ (Parent / Guardian)
Date _________________________________
E. PASSPORT
Please tick ONE box below:
1.My daughter / son will be travelling on an individual passport.
Number of Passport ___________________________________________
OR
Nationality of her / his passport ______________________________
Issued at ________________________ Expiry date __________________
2. My daughter / son will need to be included in the collective passport.
Town of birth ________________________________________________
Country of birth __________________ Date of birth __ _______________
If your child was born outside the U.K., please complete the following:
Father's full name _____________________________________________
Father's date of birth __________ Father's place of birth __________________
Number of father's passport ______________________
Place of issue __________________ Date of issue ___________________
F. CONDUCT
I / we agree that if, in the unlikely event that my / our daughter / son commits
any illegal act or behaves irresponsibly whilst abroad with the exchange group,
I / we are liable for the full costs incurred as a result of this, including,
where deemed appropriate by the group leader, the cost of transporting and accompanying
my / our child back to England prior to the group's return.
Signed _______________________________ Date _________________
PLEASE RETURN THIS FORM AS SOON AS POSSIBLE WITH ALL DETAILS COMPLETED IN FULL
WITH PASSPORT PHOTOS WITH YOUR NAME ON THE BACK.