Unique Form Participant

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1Files

2Project

3Contact

4Participant

5Details

6Welcoming

7Family

8Diet

Order number *

You or your parents have placed this order? *

Have you received the Terms and Conditions from the person who placed the order on your behalf? *

Please read our Terms and Conditions

Please read, understand and approve, with your legal guardians, the Terms and Conditions and click on the box to accept them (https://milna.org/legal) *

I, the Participant and my legal guardian(s) (if minor), declare we have read, understood and approve the Terms and Conditions of the project

Who are you? *

Minor Participant
Adult Participant
Accompanying adult

Who is really filling this form right now? *

The minor Participant oneself
The Adult Participant oneself
The Accompanying adult oneself
The legal representative of the Minor Participant
The organisation (school, teacher...)
Someone else

Are you assisted by one of your legal representative? *

Please ask one of your legal guardian to assist you while completing this Unique form. Once the legal guardian is available for you, answer "Yes" to the above question to be allowed to continue

You want to... *

Go on a Milna Project
Welcome at your home
Both : Go and welcome

Your photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Positive photo(s) that gives the desire to welcome you and know you more.

Your presentation video *

Click or drag files to this area to upload. You can upload up to 2 files.

~ 1 min duration. Loud and clear with smile. If the video is more than 128 MB, video can be sent to own Whatsapp and then saved directly from Whatsapp. It will be much lighter.

Family photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Do you have a valid passport ? *

What is your passport situation *

Not yet applied for a passport
Passport application submitted to the authority

Do you have any old passport ? *

Your passport number *

Your passport issue date *

Your passport expiry date *

Your valid passport scan (Old passport otherwise) *

Click or drag files to this area to upload. You can upload up to 2 files.

We need a flat scan made with a scanner machine, not a camera or a phone. All 4 corners of the passport should be visible.

Where do you live? *

You are welcoming a person from which country? *

To which country are you going? *

From 🇦🇪 to which France project? *

From 🇮🇹 to which project? *

From 🇱🇺 to which project? *

From 🇴🇲 to which France project? *

From 🇶🇦 to which France project? *

From 🇸🇦 to which France project? *

From 🇧🇭 to which France project? *

From 🇰🇼 to which France project? *

From 🇳🇵 to which France project? *

From 🇧🇩 to which France project? *

From 🇱🇰 to which France project? *

From 🇵🇰 to which France project? *

From 🇲🇻 to which France project? *

From 🇪🇬 to which France project? *

From 🇮🇳 to which Denmark project? *

From 🇮🇳 to which Egypt project? *

From 🇮🇳 to which France project? *

From 🇮🇳 to which Jordan project? *

From 🇮🇳 to which Spain project? *

From 🇮🇳 to which Turkiye project? *

From 🇮🇳 to which Japan project? *

From 🇮🇳 to which Italy project? *

From 🇮🇳 to which Germany project? *

For the travel insurance, we need your Pan card number *

For the travel insurance, we need the Pan card number of any of your legal guardian *

Name (owner) of the Pan card number you have provided *

Do you have your own account(s) in *

Instagram
TikTok
Facebook
Messenger
Snapchat
Whatsapp
Viber
None

Instagram ID *

TikTok ID *

Facebook ID *

Messenger ID *

Snapchat ID *

Whatsapp N° *

Viber *

Do you have your own email address? *

Your own Email *

Confirm Email

Do you have a personal phone number that is exclusively yours? *

Please reply "No" if it is the phone of your parents

Your own mobile number *

Please, only your own personal number. Else reply "No" to the above question.

The participant name EXACTLY as per the passport *

First

Last

Confirmation of the accuracy of the given name and surname of the Participant *

We, the Participant and her/his legal guardian(s), declare that we have provided the given name(s) and surname of the Participant exactly as per the passport and we are fully responsible in case of error/mistake

Confirmation of the accuracy of the given name and surname of the adult Participant *

I, the adult Participant, declare that I have provided my given name(s) and surname exactly as per the passport and I'm fully responsible in case of error/mistake

Confirmation of the accuracy of the given name and surname of the accompagnying adult *

I, the accompanying adult, declare that I have provided my given name(s) and surname exactly as per the passport and I'm fully responsible in case of error/mistake

Who is (are) ALL your legal guardian(s) *

Mother
Father
Other

Please mention ALL your legal guardians

Date of birth *

Gender *

Girl/Woman
Boy/Man
Else

Your height *

Passport citizenship *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

The name of your school *

What is your occupation? *

Who is your employer? *

In which grade are you? *

Have you traveled abroad? *

Where did you travel? *

Can you swim? *

Yes, perfectly like a fish
Needs to touch ground time to time
Afraid of the water but can go inside it
Will refuse to go inside the water
No, but I would love to learn swimming
No

Can you ride a cycle? *

Yes, I have full control of the cycle
Not great, but ready to improve
No, but would love to learn cycling
Will refuse to cycle
No

What language(s) do you know? *

Arabic
Bengali
Chinese
Danish
English
Finnish
French
German
Hindi
Italian
Japanese
Kannada
Marathi
Norwegian
Portuguese
Punjabi
Russian
Spanish
Swedish
Tamil
Telugu
Turkish
Other

Do you have any allergies or health concerns? *

Tell us more about the allergies or health concerns *

Can Milna share the allergies/health concerns with others? *

Others like: Host family, school...

Do you have any discomfort with? *

No
Dogs
Cats
Other

Please detail the discomfort *

Do you snore? *

Do you have any "talent" wanting to show during the project? *

Like singing, dancing, solving math problems, play music instrument, do magic... whatever the Participant wants to share.

What would you like to share during the project? *

Are you ok being welcomed by a boy, if staying in a separate room? *

Yes
Yes, if there is another girl of my group staying with me
Yes, if my host family has also a daughter
Yes, I can be flexible if there is no other option
No

Select all possible options

Are you ok being welcomed by a girl, if staying in a separate room? *

Yes
Yes, if there is another boy of my group staying with me
Yes, if my host family has also a son
Yes, I can be flexible if there is no other option
No

Select all possible options

Tick all situations you would accept *

I would prefer to stay alone at my host family (Milna norm)
I don't wish to stay with another person of my group at my host family
If possible, I would like to stay with another person of my group at the host family

If feasible, if you have names, with whom you would like to stay? *

What characterizes you? Tick everything matching with you! *

I'm shy
I'm quite
I'm social
I'm low in energy
I'm full of energy
I'm easy going
I like sport
I like reading
I like video games
I like dancing
I like cinema/movies/series
I like cooking
I like music
I like computer related things
I like photography
I like other things

Can you give details? *

What maximum age difference with your correspondent is acceptable for you? (in year)

Selected Value: 2

Milna target is +/- 2 years difference

Where your exchange partner will be sleeping *

"Shared room with another person". Who will be that other person ? *

"In the living room". Where exactly ? *

On the sofa
Mattress on the floor
Other

"Other". Can you give details ? *

Who lives at your place?

"Other person(s)". Can you give details ? *

"Other animal(s)". Can you give details ? *

Do people smoke inside the accommodation? *

Will the exchange partner be exposed to secondhand smoke? *

How do you get to the school? *

Select all the correct answers

"Other" Can you elaborate on your answer? *

Is it possible for you to pick up the correspondent if they return from an outing after the end of classes? *

"It's complicated" Can you elaborate on your answer? *

Mother info

Mother name as per passport *

First

Last

Mother's date of birth *

Email of the mother *

Confirm Email

Mobile number of the mother *

Father info

Father name as per passport *

First

Last

Father's date of birth *

Email of the father *

Confirm Email

Mobile number of the father *

Legal guardian info

Legal guardian name as per passport *

First

Last

Legal guardian's date of birth *

Email of the legal guardian *

Confirm Email

Who we should contact in case of emergency?

Name of the emergency contact *

First

Last

Who is this person for you? *

Email of the emergency contact *

Confirm Email

Mobile number of the emergency contact *

Do you wish to add another emergency contact? *

Name of the emergency contact n° 2 *

First

Last

Who is this person n° 2 for you? *

Email of the emergency contact n° 2 *

Confirm Email

Mobile number of the emergency contact n° 2 *

Your diet/belief allows you to eat *

Egg
Poultry (Chicken, Turkey) or similar
Mutton or similar
Pork or similar
Seafood or similar
Beef or similar
None of the above

This is not related to your preferences. Please avoid restricting yourself: If you can eat it, please tick it. It will make things easier for everyone.

Clarification needed *

If eggs are in cake/sweets, I can do an exception
I can do an exception with eggs, if it is just a minor ingredient in a processed food not having the look, taste or smell of eggs at all
I can't eat eggs at all in products having egg as ingredient even in a very small quantity

This is not related to your preferences. Please avoid restricting yourself: If you can eat it, please tick it. It will make things easier for everyone.

Do you absolutely need to eat Halal or Kosher? *

Halal
Kosher
No

Can you eat root vegetables? *

This is mostly related to Jainism diet

Please detail the restrictions *

Please detail what you can't eat due to your diet/belief. Reminder: We are not asking you if you like carrot or garlic, but if your diet/belief allows you to eat them.

Now, you can tell your preferences, go ahead! What do you like eating? *

Related to food, what do you like less? *

Anything you wish to add before submitting this form? *

Please add what you wish here *

I, Participant or/and I/we legal representative(s) of a minor Participant understand, agree and allow Milna to share the Participant basic info such as: first name, gender, diet, date of birth, photos and video... to potential host (family and/or school) *

I, Participant or/and I/we legal representative(s) of a minor Participant understand, agree and allow Milna to share the entire Unique Form Participant to the confirmed host (family and/or school) *

I, Participant or/and I/we legal representative(s) of a minor Participant understand, agree and allow Milna to share the entire Unique Form Participant to the confirmed person I'm willing to host (family and/or school) *

Email host

Host name

Email host father

Email host mother