1. Personal Data Name: ______________________________________________________________________________________ Address: ______________________________________ City: _________________________________________ Province/State: ___________________ Postal Code/Zip Code: ________________ Country:________________ Telephone: ____________________________________ Email: ________________________________________ Date of Birth (dd/mm/yy): ________________________ Age: ________________ Sex: ____________________  2. Contact Data Please give the name and the parents/guardian who consents to your participation. Name: _____________________________________________________________________________________ Address: ______________________________________ City: _________________________________________ Province/State: ___________________ Postal Code/Zip Code: ________________ Country:________________ Telephone: (home): _____________________________ Telephone: (work): _____________________________ Fax: _________________________________________ Email: ________________________________________ Occupation: ___________________________________ Signature: ____________________________________ I consent that my child/ward may participate in the Nova Languages program and agree to the terms and conditions as stated below. I give permission for photographs taken to be used for publicity purposes for the school. Person to contact in Emergency (Name/Phone/Relation): _____________________________________________

3. Health & Dietary Data *US Residents Contact Nova Languages Health Plan Number: ___________________________ Province: ____________________________________ Dietary Restrictions (ie Vegetarian): ___________________________________________________________ Please list any current medical treatments, allergies or any disabilities or fears that would require our attention. _________________________________________________________________________________________ _________________________________________________________________________________________  4. School Data Name of School: ____________________________________________________________________________ Grade: __________ French Program: Core/Basic _____ Immersion _____ Other ________________________ French Teacher: ____________________________ French Teacher Email: ______________________________ Principal: __________________________________ Principal Email: ____________________________________ School Address: __________________________________________ City: _______________________________ Province/State: ___________________ Postal Code/Zip Code: ________________ Country:________________ 5. Interests - Please tell us briefly about your leisure activities, talents and why you would like to travel to France with Nova Languages. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ REFERENCE LETTERS Two references are required (1 French Teacher, 1 personal) in order for students to be considered for the Nova Languages Summer Language  Program. Reference letters must be sent in a sealed envelope with the signature of the teacher/personal reference across the seal. APPLICATIONS A completed application will include a completed student application form, two reference letters, the initial payment and post-dated cheques. ELIGIBILITY        Students who are 15 - 18 years old and who are actively learning French. Nova Languages is not a beginner level course. However, we can offer a specialized course for a specific request to groups of at least 10 students. BOOKING CONDITIONS Deadline is March 31, 2008.  STUDENT applications are dealt with on a first-come, first-served basis. It is therefore advisable to submit your application as soon as possible. Nova Languages reserves the right to deny any application. PAYMENT INFORMATION Price TBA CDN plus airfare and medical insurance. PLEASE NOTE that the price includes all taxes. We are GST exempt. Cheques should be made payable to NOVA LANGUAGES. Initial payment $500 CDN (non-refundable) to be included with application form. This reserves the participant’s place in the program, and is  included in the total fee.   Payment of Balance Balance is due before June 01, 2008. Payments can be made in monthly instalments but if paying by post-dated cheques, they must accompany the initial payment, along the completed application form, and references. REFUND POLICY NOTICE OF CANCELLATION MUST BE MADE IN WRITING. Students who cancel before May 1, 2008 will forfeit the $500 tuition fee. Students who cancel after June 1st will forfeit the tuition fee and the cost of room and board. OTHER REQUIREMENTS Two small (school-sized) photos must be submitted to Nova Languages by June 1, 2008 to be used for the bus pass and for security while traveling. Proof of travel medical insurance must be provided to Nova Languages by June 1, 2008. Send completed application form, initial payment, references and post-dated cheques to: Mr. Gren Jones  Nova Languages  PO Box 142  Kentville, NS  B4N 3W4 Questions? Phone: (902) 679-6691 ~ Email: novalang@ns.sympatico.ca