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Personal information

First name applicant *

Please enter your first name here. If you are registering with a group, then you can add the information of the other group members later on in this form.

Preposition

Last name *

Street *

House number *

Postal code *

Place *

Country *

E-mail *

E-mail (check) *

Phonenumber *

Accommodation

Date of arrival *

Date of departure *

Accommodation *

Bed and breakfast - € 55,- p.p.p.n.
Full board (+ lunch and dinner) - € 75,- p.p.p.n.

Details of all persons, applicant included *

Please enter your own information as well as the information of the other group members here. Are you not registering with a group? Then you only have to enter your own information.

1	Name * Date of birth * Distance * Gender *
1	Name * Date of birth * Distance * Gender *

Extra persoon

Do you object to sharing a double bed with someone from your group? *not applicable if you signed up alone *

This only applies if you are booking for a group.

Do you object to sharing a room with someone from your group (two beds)? *not applicable if you signed up alone *

This only applies if you are booking for a group.

Preferences

Do you mind sharing a room with a stranger (two seperate beds) when there are not enough rooms available? *

We are trying our best to keep everyone’s wishes in mind. However, we might not be able to create the perfect match as there might not be enough rooms available. Please keep that in mind.

Are you allergic to pets?

If so, namely

Do you want to eat vegetarian? *

Important information for the host family (this is read by the host family)

Describe here any information or wishes for the host family

I have something special to report such as: Special request due to a disability. Stay with the same host family as last time. Sleep with a friend in the same room who has already been registered in a different booking.

If there are specifics that the organization must take seriously into account when looking for a host family, such as a physical disability. Things worth knowing for the host family can be filled in above or agreed with each other at a later stage.

Please contact me

Explanation

Describe your special circumstances

Payment

Summary

I know I am not allowed to smoke inside during my stay at Vierdaagsebed. *

I agree with all terms and conditions of Vierdaagsebed *