Online registration for participants in the international youth exchanges 2017 et seq.

Registration for the trip with JugendInterKult e.V.

Crete presumably  8 – 22.04.2017 | Travel costs: €560 (1. instalment: €220,  2. instalment €340)

Rome 15 – 22.7.2017 | Travel costs: €390 (1. instalment: €150, 2. instalment €240)

Israel-P.-J. presumably 20.10. – 5.11.2017 | Travel costs: €890 (1. Inst.: €360, 2. Inst. €530)

More information about the program under International youth exchanges 2017

Personnel data of the participant

First name

Name

Sex

Street / house number

Postal Code

City

E-mail address

Cell phone no.

Date of birth *

Place of birth / country

Nationality

*Age generally 16-25 years. Otherwise contact JIK directly.

Swimmer / non-swimmer

Diseases / allergies

Regular medication intake / if not applicable enter "none"

Particularities in the case of food /  if not applicable enter "none"

Other particularities /  if not applicable enter "none"

I herewith grant my consent/ do not grant my consent for the provision of necessary medical care of any kind for my son / daughter.

To be completed only in the case of school-age participants

School / Please select appropriate

BKO, Department Business and Administration etc., Stauffenbergstr. 21-23, 51379 Leverkusen

BKO, Department Education and Social Services, Düsseldorfer Str. 8a, 51379 Leverkusen

BKO, Department Health, Fürstenbergstr. 1, 51379 Leverkusen  

Please specify the exact class designation as well as the first and last name of the class teacher.

Other school, namely ... (name and address of the school, exact class designation, first and last name of class teacher)

Only in the case of trip 3  | Passport available or not (please select)

Available and valid up to at least 6 months after the end of the trip

Not available. I will promptly procure a passport.

Participants-custodian  (Not required if the participant is over 18 years of age  a n d  a self-payer)

First name

Name

Sex

Street / house no.

Postal code

City

Nationality

Cell Phone no.

I / we have read the General Terms and Conditions of the International Youth Exchanges of JIK as well as the special information on the program of these trips and recognise them as an integral part of this contract.

The 1st  instalment is due 14 days after the contract is concluded (receipt of payment).

The 2nd instalment is due 10 weeks before departure (receipt of payment).     

Account details/ account holder:

JugendInterKult e.V. |  BIC:  GENODED1BRS |  IBAN: DE09 3806 0186 0704 8870 19

Very important:  Purpose: e.g. JIK-Trip No. 1, participant name + 1st or 2nd instalment

The participant will undertake, following the conclusion of this contract, to promptly introduce himself/herself via e-mail (profession / school, with knowledge of foreign languages and foreign experience, etc.), (at the latest within 14 days) and to explain why he / she wants to participate in this trip.

The participant declares his/her willingness to participate in all mandatory and yet to be agreed upon planning meetings for this trip, to independently and impartially intensively get acquainted with the culture, history, religion and current political developments in the country, to participate during the trip in all fixed program points, to promptly reply to all e-mails concerning the trip, as well as to observe the information entailed therein.

I herewith as the custodian, in a legally binding manner, register my daughter / my son for the selected trip and I am liable for the payment thereof.

Please enter the characters from the field in the row.

= adequate places available

= only few places available

= booked up, but you can put on the waiting list