Application
(L12-02)
|
| Name |
|
| First name |
female 
male
|
|
|
Exact address
(incl. phone and country) |
|
|
| Nationality |
|
|
| Birthday (dd, mm, yy)
|
|
|
| Training(s) / Profession |
|
|
|
| I
speak and understand |
German |
well |
|
reasonably
|
|
badly |
|
|
French
|
well |
|
reasonably
|
|
badly |
|
|
English
|
well |
|
reasonably
|
|
badly |
|
|
|
| I would like to come |
from |
|
till |
|
|
|
| Special
wishes: |
| German speaking
part |
|
French speaking
part |
|
| in the valleys
|
|
rather In the
mountains |
|
| Stable work |
|
Work in the fields |
|
| Household chores |
|
Child care |
|
|
| and / or (e.g. special
areas) |
|
|
|
|
| What is you motivation for
a farm stay (if necessary join extra sheet)? |
|
| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| Have you ever worked on
a farm before? |
Yes |
|
No |
|
When,
where and how long for
(use extra sheet if necessary)?
|
|
|
|
I acccept the General Terms and Conditions as shown on the website
I shall pay the registration fee:
per cheque here joined
per 116 Euro in cash
Transfer to interconnections, acc. 688 5438, Volksbank Freiburg, BLZ 680
900 00
Remarks (e.g. health problems)
|
|
|
|
|
| Date |
|
|
| Signature of applicant |
and of parent
(if minor) |
|
|
|
|
Please send via mail to: interconnections,
Schillerstr. 44, D - 79102 Freiburg, Tel. 0761 700 650, Fax 0761 700 688
|
