Registration

Your daughter / Your son
Fields with an asterix (*) must be filled in
Daughter/Son*	My sonMy daughter
First name*
Last name*
Date of birth*
Grade*
Type of school*

Parents resp. Guardian
First name*
Last name*
Street*
City*
Postal Code*
Country*
Telephone number°*
Fax
E-Mail*
My e-mail address may be used for information from Studienhaus Landau

Course Information
Please choose the course and provide us with the dates:
Place of course*
Timeframe of course*	from: through:

1st subject*	(if foreign language, lessons since which grade?)
2nd subject	(if foreign language, lessons since which grade?)

Arrival and departure
1. Arrival and departure (offered bus service)
Please only list the cities, which are listed at the specific course
Outward journey from
Return journey to
2. Arrival and departure (own mode of travelling)
arrival by cararrival by train/aircraft
return by carreturn by train/aircraft
In order to to have a carpool, my address may be provided to other parents

Others
1. Boarding The students wants to reside in the same room with :
Name
2. Sibling discount We want to take the sibling discount (brother or sister):
Name
3. Please note: e.g. vegetarian, a special diet, regular medication, allergies, etc.
note

Payment
* - The down payment of 10% is due upon receipt of the course confirmation and the course contract. When making the payment from a bank outside of Germany, please instruct your bank staff to debit all charges to your own account – thank you --- The remainder of the amount will be paid upon receipt of the course instructions („Elternbrief“). ---
Terms and conditions:
*- I agree with the terms and conditions and protection of data privacy of the Studienhaus Landau. AGB protection of data privacy
Register