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Preliminary Application
Apply early– we accept only 16 students per program.
On receipt of this preliminary application, we send you the complete admissions packet which we review in the order they arrive.
Please complete this preliminary application and mail it to: Dr. Bert Whetstone Adventures in France 734 North Main Street Laconia NH 03246-2777
Note: Purchase airline tickets only after receiving written confirmation of admission to the program.
Date: July 10 - 23, 2008
__________________________________________________________ Student’s name E-mail
__________________________________________________________ Preferred first name Male/Female Birth date
__________________________________________________________ School Location Current Grade
__________________________________________________________ Father’s name Occupation E-mail
__________________________________________________________ Mother’s name Occupation E-mail
Mailing address:__________________________________________
__________________________________________
__________________________(____)___________ Preferred Telephone
Admissions: We screen for student compatibility with program goals. Payment and Refunds: A $500 deposit is due with the admission packet, or you may reserve a place by sending the $500 deposit with this preliminary application. We refund your full deposit if your child is not accepted. Accepted students who withdraw prior to March 30 receive a $250 refund. Accepted students who withdraw after March 30, receive no refund. Payment balance ($2450) is due April 30, 2008.
__________________________________________ Signature Date
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