Centro Superior de Lenguas Modernas (CSLM)

Housing and medical form

Name *

Surname *

Sex *
Male Female

Date of Birth

Passport

Home address

City/Country

Nationality

Zip code

Email *

Phone number

Cell number

Name of your university

Accommodation service *
Full board Half board Mix-acommodation (only for groups under request)

Date and Time

Place in Cadiz *
Bus station Train station

Date and Time

Place in Cadiz *
Bus station Train station

Are you diabetic? *
No Yes

Do you have asthma? *
No Yes

Are you generally in good health? *
No Yes

Will you be taking medicine with you? *
No Yes

Do you have any eating disorders? *
No Yes

What diseases, illness, if any, have you had in the past five years? *
No Yes

Have you ever been treated for any emotional disorder? *
No Yes

Are you currently under medical treatment for any reason? *
No Yes

Do you have any allergies to medications? *
No Yes

Any food concerns or special diet?
Diabetic Gluten-Free Others Vegan Vegetarian

How stronger you feel about being in a family with smokers? *
Indifferent Slightly against Strongly against

Dog * No Yes

Cat * No Yes

Other animal * No Yes

Other allergy

Any further information or request that you think are important to you or that we should know

I have read and accept the terms and conditions and the legal notice

Términos y condiciones | Aviso Legal