Registration Form -Youth Exchange - KA 1

Registration Form -Youth Exchange - KA 1

1,2,3,ACTION !!! -Sarata Monteoru -Buzau ( Romania ),

30 may-9 june 2017

Contact Details
Family Name /

First name

Nationality / Date of birth
Gender / Male / Female / Place of birth
Address / Mobile phone
Postal code
City / E-mail
Country / Facebook
Passport or ID no
Languages Spoken
English / A1 A2 B1 B2 C1 C2
A1 A2 B1 B2 C1 C2
A1 A2 B1 B2 C1 C2
Special Needs
Diet / I eat everything unless it’s gone off :P
I do not eat PORK
I’m a vegetarian - I do not eat MEAT , but I eat cheese and eggs
I’m vegan - I do not eat MEAT ,NOR eggs and cheese
I’m allergic to______(please, specify)
Others / (allergies, medicine, reduced mobility, etc...)
Emergency Contact Details
Family Name /

First name

Languages Spoken
Telephone
E-mail
Organization you represent
Name /

website (www)

Facebook
Country
What’s your role in the organization?
In what kinds of activities in your organization did you participate?
How will your organization/association benefit from your participation in this activity?
Are you responsible for project writing?
Yes / No
Motivation and Experience
What is your work experience ? Did you have any interviews for job ?
Why would you like to take part in this activity?
Do you believe in love at first sight ? Why ?
Do you have previous experience with international events like this one?
Name 3 things you want to take with you on an isolate island ...
Participants’ travel cost
Please note that only cheapest means of transport and fares are subject to reimbursement (APEX airfare, 2nd class train ticket, etc.). We do not reimburse taxi costs. ( To be completed after the selection of the participants)
Participant’s name / From / To / Means of transport / Costs / Arrival time in Bucharest airport/ train
station / Departure time from Bucharest airport/ train
station

Please, remember that:

´  Obtaining a full travel insurance policy is the participant's responsibility

´  Providing the above information about special needs does not remove your own personal responsibility for ensuring your own safety.

´  To send us a copy of your tickets and invoices when you booked them is your obligation

Declaration:
I agree that once admitted to the activity my personal data given in this application form may be made available to other entities according to Erasmus + rules .

Yes No

I agree that the photos and images (taken during the activities) where I appear can be used by organizers and its partners in publications, websites, and projects to promote Erasmus + Programme addressed to general public.

Yes No

Place: Date: Signature:

Youth Exchange description

Participants: youngsters 18-25 years old (one participant per group can be over 25 years old up to 29) and group leaders without age limit

OBJECTIVES :

The objectives are :

-to identify and aware the causes and effects that facilitate increasing of vices and passive lifestyle and to understand bad effects at physical,mental and social level

-to promote ways of action and intervention at physical,mental and social levels to decrease and eliminate effects of inactive and unhealthy lifestyle

-to promote sports ,physical educationand healthy alimentation through nonformal education ,media and video creation to increase quality of life

-to increase self confidence of fewer opportunities youngsters and encourage their social inclusion by offering them alternative activities that sustain creativity,active participation and mobility

-to provide for 42 youngsters and 8 group leaders from 8 contries a common space to reflect on a better unserstanding of cultural diversity and european cooperation

ACTIVITIES: - games – ice breaking , socializing ,role plays

- thematic and creative workshops : see activities programme

- cultural visits in Monteoru,Buzau and surroundings

- intercultural evenings and Romanian traditional night

Venue: Sarata Monteoru and Buzau , Romania

Accomodation and food : Pensiunea Casa cu Tei Monteoru ; B90 Sport Hotel in Buzau ( rooms of two – three persons with private bathroom and shower ) ;

Activities : outdoor and at the locations

All participants will receive youthpass certificate

Contact :

I ,undersigned ...... as a participant in this exchange understand that i am aware about objectives of the project,my role during the activities and my individual learning objectives as stated here,in daily agenda,in infopacks and in all communication with organizers ,my sending organization and my group leader

Place: Date: Signature: