2. School or University Information

# ______

Camp “Republic”

March 24^th-25^th

Application form

1. Contact Information
Name (first and last):	E
Date of birth:
Address:
Cell/Home phone #:
E-mail address:
2. School or University Information
School/ University attending:
Specialization:
Year of study:

3. Rate your level of English ability in

My Self-rating of my ability in

SKILL AREA	Excellent	Good	Fair	Poor
Listening
Speaking
Reading
Writing

4. In order to participate in Camp Republic, you must accept the terms and conditions of the camp. Campers should refrain from any use of drugs or alcohol; any students caught with these substances or under the influence of them will be immediately removed from the camp at their own expense. Absolutely no fighting or use of discriminatory language will be tolerated and will be met with immediate removal from the camp. All campers must be 15 years or older by start of camp. Furthermore, Peace Corps and Poltava Institute of Economics and Law are not responsible for any lost items, or personal injury and health issues due to negligence.

5. Cost to participate in the camp is 30 UAH. Please plan to pay upon handing in your application or when arriving at camp.

The Poltava Institute of Economics and Trade; Kotlyarevskij St. 1/27

Дата добавления: 2015-11-04