REGISTRATION FORM - Qilineduc

IDENTITY *

First

Last

First name / Family name

LEGAL GUARDIAN

First

Last

First name / Family name *Necessary for under 18

LEGAL GUARDIAN PHONE NUMBER :

LEGAL GUARDIAN EMAIL : *

DATE OF BIRTH *

EMAIL *

PHONE NUMBER *

EMERGENCY NUMBER

ADDRESS *

Address Line 1

City

State / Province / Region

Postal Code

Country

APPRECIATED SPORTS

HOBBIES

Additional information you want to let Qilin know

Options

COURSE *

Arrival date *

(Sunday)

Departure date *

(Saturday)

ACCOMODATION

TYPE OF ACCOMODATION

EXCPECTED DATES

INSURANCE *

Check this box if you subscribe to Personal Accident Insurance (Federal License) through Qilin. This insurance does not include repatriation
I already have insurance

Insurance company name

address

Insurance contract number

Information, only on Qilin's activities, is sent to me occasionally by e-mail *

Photos of my person, individual and collective, are taken and used by Qilin on social media, promotional materials: *

Signature *