PRE-ENROLLMENT FORM
Spanish Literature program for High School Students
Summer 2015

 
PERSONAL INFORMATION
Name (as it appear on your passport)
Last name Middle name First name
Gender:
Male
Female
Date of birth
/ /
Student´s Nationality (as indicated in passport):
Passport number:
Expiration date:
Home address* (The Certificate of participation will be sent to this address.):
City: Country: Zip Code State:
Home phone: E-mail:
Emergencies:
Full name to notify in case of emergency:
Relationship:
Address of emergency contact:
City: Country: Zip Code State:
 
Home phone: E-mail:
Work phone: E-mail:
Cell phone:  
 
Other phone:  
 
EDUCATIONAL INFORMATION
 
High School grade level:
School name:
School district:
School address:  
 
City: Country: Zip Code State:
 
Spanish Language and/or Literature Courses you have taken:
 
When do you expect to take the AP Spanish Literature Exam: Language Exam:
 
May 2016 May 2017 May 2018 Other
 
Have you traveled abroad before? If yes, please specify:
Have you ever been to Spain? If yes, please specify:      
I AM APPLYING FOR:
 
 
The session July 2015, INTERNATIONAL HOUSE MADRID, Spanish Literature
 

In Spain the student will take a Placement Exam (in order to test the student's level of the Spanish Language)

 
The lodging:
 
In a Spanish Family In a Student Residence
Single Room Single Room
Double Room Double Room

Please note that specific housing requests cannot be guaranteed and that single rooms are not available in all the schools and generally reserved for those with special needs.

 

Do you have a special diet (e.g. allergies to certain foods or vegetarian)?

 
Yes
No
If yes, please specify:
 
Are you allergic to house pets?
 
Yes
No
If yes, please specify:
 

Do you have any other allergies or chronic ailments that the host organization should be aware of?

 
Yes
No
If yes, please specify:
 
Are you taking medication for any physical or mental conditions?
 
Yes
No
If yes, please specify:
 
Do you have any special needs which would make it difficult for you to walk long distances or to climb stairs?
 
Yes
No
If yes, please specify:
 
Roommate preference (if attending with a group). Name:
 
Do you consider yourself a quiet person?
Yes
No
 
Are there any hobbies or interests that you would like to pursue while in Spain? If so, please specify:
 
HOW DID YOU HEAR ABOUT THIS PROGRAM?
 
Education Office (Embassy of Spain )
Leaflet about the program
A teacher
The Web
A friend
Others. Specify:
 
IMPORTANT DATES
 

January – April, 2015:

1. Students should enroll online ( http://ap-spanish.com ) and send the Payment Sheet and a non-refundable deposit by fax or mail before April 30, 2015.

2. Student’s enrollment will be confirmed prior to May 15, 2015. At that time, they will also receive instructions on how to submit payment for the total cost.

3. Students must send the final Enrollment Form with full payment of total cost prior to May 23, 2015. Students will not be considered officially enrolled until full payment has been confirmed.


 
 
May 2015

1. Students will receive information from the family with which they will stay as well as detailed information from the school two weeks before the beginning of their course.

2. Flight information should be provided on the final Enrollment Form (which must be submitted prior to May 23, 2015) so that he or she can be met at the airport. The deadline for sending student flight information is May 15, 2015.

AGREEMENT AND RELEASE CONDITIONS

1. Please, check that:

You have read the payment schedule and refund policy posted on the program Web site.
You have read the conditions of the housing policy.
You have the appropriate VISA if you are not a U.S. or Canadian citizen.
You have included accurate information about any medical conditions or needs.
You have included accurate information for an emergency contact person.

2. You understand that ...

This agreement is a legally binding contract and you (or your legal guardian if you are a minor) have read and accepted the terms and conditions set forth in the Spanish Literature Courses for High School Students program information brochure and on the Web page which are incorporated in this agreement.
This agreement can only be modified in writing by Eduespaña or the Education Office .
This agreement will take effect when your application is accepted by Eduespaña and will be governed by Spanish law.
If you leave the program once you are in Spain , there will be no refund (program cost nor lodging fee).
You need to have or obtain a passport and any other required travel documents. This is your (or your legal guardian's) sole responsibility. If you are not a citizen of the United States or Canada , it is your (or your legal guardian's) responsibility to obtain all visas and documents that may be required in order for you to enter Spain and participate in the program. You understand that an inability for you to obtain a visa or other necessary documents does not constitute grounds for withdrawal from the program with a refund.
You are responsible for exercising caution and common sense at all times in order to avoid damages and injuries. The school cannot provide supervision during periods of independent activity.
The school provides insurance coverage while in the program, including limited health, accident and accidental death. You acknowledge that it is your (or your legal guardian's) responsibility to understand the limitations of this coverage and you agree that the school is not responsible for any uninsured losses.
The future program and school publicity material may include statements and photographs of the participant. You have given your consent for your statements and photographs to be used in the future.

3. You agree that ...

The school reserves the right to make changes, cancellations or substitutions in case of emergency or changed conditions, or if it deems such changes to be in the interest of the group.
You will comply with the school rules and instructions. Failure to do so may be grounds for returning to U.S. or Canada at your (or your legal guardian's) expense with no refund. You understand that your participation will be terminated if you are expelled from the school or disciplined by civil authorities. Also, termination may occur at the school's discretion if it is determined that your conduct is incompatible with the interest, harmony or welfare of the rest of the students. You (and your legal guardian) agree to indemnify the school if you do anything that causes the school to sustain financial loss or liability.
If you become ill or incapacitated, the school may take such actions as it considers necessary under the circumstances, including securing medical treatment for you and transporting you to the United States or Canada . You release Eduespaña, , the school and the Education Office from any liability relating to this medical care. You also authorize Eduespaña and the school to take whatever action it deems to be necessary and in your best interest (including transportation out of Spain back to the United States or Canada at your own or your legal guardian's expense) in the event of political unrest or any other unforeseen condition. If the school incurs any expenses on your behalf that is not covered by insurance you (and your legal guardian) agree to repay this expense immediately upon your return.

4. You release unconditionally ...

The Education Office, Eduespaña and the school from any claims for damage, injury, loss or expense of any nature resulting from events beyond their control, including without limitation acts of God, war, strikes, crime, terrorism, sickness or quarantine, government restrictions or regulations. This release applies to any losses arising from the use or any act of omission by any host family, bus or car rental agency, steamship, airline, railroad, taxi or tour service, hotel service, hotel restaurant, school, university or other firm, agency, company or individual, unless the loss is caused by the gross negligence of the school.

5. You accept ...


To keep the schedule set by the school and to attend all your daily classes and all programmed activities.
To keep the schedule set by the school with the families when going out at night, for meals, etc.
To take proper care of your school and home environments.
Not to consume alcohol under any circumstance.


Please, check to indicate your agreement:

I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS ABOVE:


YES; SIGNATURE