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Havisham Park

Application form

First Name*
Surname*
Date of birth
Grade/Class
Period*
from (date)
to (date)
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Please, quote me an accomodation LuxuryComfortBasic
Spiritual assistence required YesNo
Please include all relevant information about health facts (allergies, terapies, ecc..)
Information about the parent/guardian (name, address, phone, e-mail…)
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* Read the Informations Privacy (art. 13 - D.Lgs. 196/2003) i approve for the treatment of my personal dates.
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