South Africa
Application Form

Agrafez ici une photo d’identité

Réservé à BEST : Please, fill in this form in English. Name :

Cape Town

Period :

............................................................................................. ................................................................................... ............................

How many years of English study ? : Is it your 1st linguistic stay ? : yes

.............................

First name :

no

Date of birth : ..................................... Age :

Male

Female

Father’s occupation : ........................................................................ Mother’s occupation : ......................................................................

Address : .................................................................................................
.......................................................................................................................

Telephone : ............................................................................................ Special diet : Smoke : Character Adaptibility Observations :
................................................................................ Allergies

:

……………………………………………………………………………...

yes Shy Good

no Reserved Easy going Average Quiet Don’t know Dynamic

At ........................................................................... on ...........................................................................
Signature student parents or tutors

Medical release : I, ……………………………………………………….., as legal guardian of ………………………………….. (prénom et nom du responsible legal) (prénom et nom de l’enfant) …………………………………... allow the hospital to perform any surgical operation on my child. I also grant BEST leaders permission to act as legal guardians especially in medical emergencies including cases of a surgical operations. At : (lieu) …………………………………………………… On : (date)