Pupils, Students, Apprentices

Please note that an application is only possible and complete with your correct declarations. Your personal data will be handled confidentially and won't be given to any third party.
The orange colored fields are required form fields.

General declarations	Additional Information
Time of entering the dwelling house 12345678910111213141516171819202122232425262728293031 123456789101112 201220132014 Catering Please choose ... No catering Breakfast Half board (Breakfast + Evening meal) Type of room: Single Room Twin Room	Subject of your study Apprentice School - Address School Telephone Number Vocational school Weekly times
Personal Data	Next of kin
I am ... Student Pupil Apprentice Other	First name
Title Mr. Ms.	Last name
First name	Date of Birth (Day Month Year) 12345678910111213141516171819202122232425262728293031 123456789101112 194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002
Last name	Street
Date of Birth (Day Month Year) 12345678910111213141516171819202122232425262728293031 123456789101112 1960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002	Zip code / City
Street	Telephone Number
Zip Code / City	E-Mail
E-Mail	Job
Telephone Number	Employer
Religion	Guardian, Department of youth in charge or any other contact person
Citizenship
Diseases / Allergies
Insured Person
First name
Last name
Health Insurance company
Insurance number
Employer
Additional Insurance's
General physician
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