PLANETE BLEUE
Carrefour de vie étudiante
Inscription form for a stay during Summer 2018
Last name: ...... First name: ......
Date of birth : ...... Civil status:......
Nationality: ...... Native of: ......
Actuel address Street: ......
Area code: ...Town: ...... State: ......
…..……………………………… e-mail: …………..……...……….……..…………………….……..……
Parents or guarantor’s name and address Last and first name: ……………………………………………………
Street : ......
Area code: ...Town: ...... State: ......
School – University – or other Institution to attend:……………………………….…………………………
…………………………………………………………………………………………………………………………………………………
Planète Bleue offers single and double furnished rooms with mezzanine, dispatched in 10 apartments composed by 3 to 5 rooms with kitchen, little dining and living room, showers rooms and WC, internet Wi-Fi included.
Single room / Double room(price splited in 2 parts/pers.for 2 occupancies)
Room’s price / + Taxe de séjour per pers. / Room’s price / + Taxe de séjour per pers.
1 week / chf 220.- / + 13.-- / 1 week / chf 315.- / + 13.--
2 weeks / chf 440.- / + 27.-- / 2 weeks / chf 630.- / + 27.--
3 weeks / chf 650.- / + 40.-- / 3 weeks / chf 910.- / + 40.--
4 weeks / chf 850.- / + 54.-- / 4 weeks / chf 1’165.- / + 54.--
Taxe de séjour exempted on production of a certificate: permanent home address registeredwith the office of inhabitants of Lausanne(or secondary residence registered for Swiss citizens).
I register for a single room.
I register for a double room with:
Last name: ………...... First Name: ……………………………..nationality: ....………..
date of birth: ………………..…….…e-mail: ......
I register for a period of time of ….... week(s),
from *Saturday: ………………………………………. until *Saturday: ……………………..……………..………….
*Rent is Saturday to Saturday;a part of a week will cost the price for the whole week
except for a stay until end of August, price of the last week will be calculated
until Friday 31.08.2018.
Date and time of arrivalat Planète Bleue: Saturday: ……………………………..…………………………….
Time(from16h00 until 20h00): ……………………………..………………………….....…...... ……………………………...
It will be important to confirm your arrival time at Planète Bleue 2 or 3 jours before, for your welcoming.
By signing, the roomer will accept house rules of Planète Bleue
-
Place and date: ………………………………………. Signature: ...... …………………
11.01.99/HR/ad