Toscana Saporita Registration Form

THE FOLLOWING INFORMATION IS NEEDED FOR YOU TO BE PROPERLY REGISTERED HERE AT LA CASA ROSSA. IN ADDITION WE WILL USE YOUR ADDRESS IN THE STUDENT ROSTER THAT WILL BE DISTRIBUTED TO ALL STUDENTS IN YOUR CLASS AT THE END OF THE WEEK. IF YOU DO NOT WISH YOUR NAME AND ADDRESS TO BE ON THE ROSTER PLEASE ADVISE US WHEN HANDING IN THIS FORM. THANK YOU !!

First Name / M.I. / Last name *

First

Middle

Last

Place of Birth *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Email *

Email

Confirm Email

Contact Phone Number *

Passport Number *

Passport Date *

Place of Issue *

Arrival in Pisa (AIRPORT or RAILWAY STATION)

Flight number

Airline

Arrival time

Train number

Arriving from

Arrival time

Contact person in case of emergency (name & phone) *

Departing From / Airline ,Train / Time *

Security Measures

There is a safe in your room and in the main office that is available to all students. We advise you to keep your valuables and/or your passport locked in the safe and we will be happy to arrange this for you. We are otherwise not responsible for any loss or theft.

Privacy Policy *

I have read the privacy policy and agree to receive e-mails

Photo release

During your stay here many candid pictures will be taken. Some will be used on social media and on our web page. Your signature below will allow us to use any pictures for these purposes. Thank you!

Share photos *

I agree
I disagree

Date *

Signature *

Clear Signature

Arrival in Pisa (AIRPORT or RAILWAY STATION)

Security Measures

Photo release

Would you like to become our ambassador?