Royal Language

CHAPERONE APPLICATION FORM

About You

First name	Last name
Date of birth	Place
Address
City
State
Zip Code
Country
Home tel
Mobile tel
Nationality
Gender	Female Male
Age
E-mail

Personal Info

Civil Status	Single Married
Occupation
Spouse's Occupation
Phone (mobile)
Smoker	Yes No

Number of sisters and ages
Number of brothers and ages

Medical Information

Vaccinations	Tuberculosis Tetanus Measles Polio
ALLERGIES If yes please explain.
Are you on medication?
Blood type
Smoker	Yes No

Hobbies and sports
Do you play any instrument?
Please list the countries you visited
Favorite food
What do you do in your spare times?

GUIDELINES FOR CHAPERONES
VERY IMPORTANT

You need to know that in the States, it’s is UNLAWFUL for minors to smoke, to be in possession, to buy or to sell cigarettes, and be fined minimum $100 or community work sentence and even prison. IT IS YOUR RESPONSIBILITY TO MAKE SURE YOUR STUDENTS UNDERSTAND AND CONFORM TO THIS LAW. No students will be allowed to smoke in the States. FAMILIES WILL NOT ACCEPT SMOKERS. IF STUDENT SMOKES, FAMILY WILL TERMINATE HIS STAY. It is also forbidden to smoke all indoor areas. None of the families smoke.

In Virginia, California and Florida, it is illegal for under 21-year-olds to possess or consume alcoholic beverages. IT IS YOUR RESPONSIBILITY TO MAKE SURE YOUR STUDENTS UNDERSTAND AND CONFORM TO THIS LAW.

ANY STUDENT WHOSE CONDUCT IS SERIOUSLY UNACCEPTABLE OR DETRIMENTAL TO THE PROGRAM OR THE HOST COMMUNITY WILL BE DISMISSED FROM THE PROGRAM AND RETURNED TO HIS/HER NATIVE COUNTRY AT NATURAL PARENTS’ EXPENSES AFTER CONSULTATION.

I Accept I do not accept

CHAPERONE LETTER
Please write a letter to the host family. This is the very important part of your application. Here, you will have the opportunity to reveal your true personality. Do not waste this space repeating information you have provided elsewhere in this application.