Application form
Please fill in the form below. Required fields are designated with a red star.

.
To:

The Little Country School

*Please enter your name:

* M | F

Date of Birth

Month Day Year

*Email:

*

*Address:

*

Tel:

Emergency Contact Person:

Tel:/

Relation:

Members of your group:
Name: M F DOB: Month Day Year
Name: M F DOB: Month Day Year
Name: M F DOB: Month Day Year
Name: M F DOB: Month Day Year
Name: M F DOB: Month Day Year

Select a course:

Organic Food and Farm Tour
English and Country Life Course
Organic internship
Customized Tour

Start Date (If you know) Month Day Year

What is your English level? Please fill in how many people for each box.
None
Beginner
Travelers English
Intermediate
Almost Fluent
Native

Request or something you wish to tell The Little Country School in advance (allergy, Vegetarian, home stay requests, special needs etc.)

You must have your own travel insurance.

The little country school is not responsible for personal injury, accidents, loss of possessions or any other issues as defined in the terms and conditions below. Term and conditions:

Do you agree with our term and conditions?
Yes | No

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