Instruction

1) Fill all fields only electronically (not hand writing or scans).

2) **Send the application form without signature with only electronically-filled fields to our email.
You will sign the application form the first day of project activity.
3) If you cannot fill the fields or cannot save the application form use the correct software: Adobe reader
https://acrobat.adobe.com/us/en/acrobat/pdf-reader.html
4) We will make one international transfer for one country for refunding travel costs, so write the same bank details to all
application forms for your country or fill only bank details in one application form.
5) Fill also page 4 - Content of processing personal data.

T-shirt - male

T-shirt - female
 Tales from the lens - Training course 1 2019-1-CZ01-KA105-061028

Date: 7th - 13th of October 2019

Location of activity: Hotel Athenaeum, Via L. Giannettino N. 4, Palermo, Italy
Participants details:

First name: Family name:

Gender: male female Date of birth: ID Nr.*:

Adress: Country:

Phone: Email:

* Please, write the number of ID you are travelling with. We need it for accomodation
Sending organisation:

Name

Special need:

Food requirements (vegetarian, vegan, special diets etc.) - Otherwise leave blank

Medical condition (important for outdoor activities)

Any other special needs or questions - Otherwise leave blank

T-shirt size: Please choose only one posibility. Size specifications are on the first page.

Male XS S M L XL 2XL

Female XS S M L XL 2XL

Youth worker: Yes Not

Your English skills: Fluent Good Satisfactory Poor

TRENDUM, o.p.s | Těšínská 236/244 | 716 00 Ostrava Radvanice

+420 731 625 895 | trendum.ops@gmail.com | www.trendum.cz
IČ: 02564041 | Číslo účtu 2000543151/2010
Describe shortly the organization in which you work as a youth worker and about your role.

What is your experience with Erasmus+ project ?

What is your experience with photo and video topic ?

Describe your motivation. Why would you like to participate ? What do you want to learn ?

Bank details: (for reimbursement of travel costs, it is possible to use only 1 bank details for one country, so write the same details as the other participants)

IBAN (or account number for Czech R.): BIC (SWIFT):

Name of the bank: Bank adress :

Account holder (the participant's name or organization):

I declare that I will also attend the Training course 2. Yes Not

I declare that I will be covered by own travel insurance for the duration of the project and for travel to the project and back. Travel insurance includes accident
insurance, luggage insurance and liability insurance. Yes Not

Date: Signature**: ______________________

TRENDUM, o.p.s | Těšínská 236/244 | 716 00 Ostrava Radvanice

+420 731 625 895 | trendum.ops@gmail.com | www.trendum.cz
IČ: 02564041 | Číslo účtu 2000543151/2010
 Content of processing personal data
according to the EU regulation 2016/679 (GDPR), („The Content“)

First name: Family name:

Date of birth:

I. You are giving your consent to organisation TRENDUM, o.p.s, Těšínská 236/244, Ostrava, Czech Republic, ID 02564041 („Administrator“) to process
data mentioned in article IV., according to the regulation of European union, made by European Parliament and Council of the European Union, on the
protection of natural persons with regard to the processing of personal data and on the free movement of such data, GDPR („Regulation“).
II. Personal data are processed for the need of participant evidence of educational event Training course 1 and 2 within the project Tales from the lens,
nr. 2019-1-CZ01-KA105-061028, financed by the programme Erasmus+ youth - for the need of organisational assurance, realisation and dissemination of
this event.
III. Personal data are gained from subjects by acceptance of filled PDF form „Application form.“ Data are merged to the comprehensive list of
participants of educational event and saved to protected Dropbox cloud account.
IV. Personal data, that will be processed, and purpose of proceeding:
- First name and surname, sex, date of birth, country - for the purpose of evidence of participation in mobility, requested for exploitation of grant
budget in the programme Erasmus+, in the form of „List of participant“ and evidence in online system of European commission https://webgate.ec.europa.
eu and for assuring the accommodation of participant.
- Adress of residence, number of personal ID or passport - for the purpose of assuring the accommodation of participant.
- E-mail adress - for the purpose of evidence of participation in mobility, requested for exploitation of grant budget in the programme Erasmus+, in the
form of „List of participant“ and evidence in online system of European commission https://webgate.ec.europa.eu and for assuring the communication and
information transfer within the project period.
- Phone number - for the purpose of assuring the communication with participant before the event start and for assuring his/her safe arrival to the
educational event.
- Sending organisation - for the purpose of evidence of participation in mobility, requested for exploitation of grant budget in the programme Erasmus
+, in the form of „List of participant“ and evidence in online system of European commission https://webgate.ec.europa.eu
- Dietary needs - for the purpose of assuring the special dietary needs of participant.
- Health condition - necessary for the purpose of detection of any limitation for participation in outdoor activities.
- Bank account - for the purpose of reimbursement of travel costs via transfer to bank account of participant.
- Photographs, Audio/video records - taken within the educational event for the purpose of dissemination and visibility of the project, and visibility of
Administrator.
V. Personal data provided to another subjects:
- Provider of accommodation: Servizi Alberghieri S.R.L., Via Generale Euclide Turba n.3, 90128 Palermo - provider of Hotel Athenaeum, Via L.
Giannettino N. 4, 90128 Palermo and Ing.Hila Ivo, Čechovova 2, 716 00 Ostrava-Radvanice - provider of hotel Taurus, Těšínská 1382/260, 71600 Ostrava
Radvanice- for the purpose of accommodation of participant in the form of “List of accommodation”, there will be following data provided: First name and
surname, date of birth, number of ID or passport, address of residence and country.
- National Agency of Erasmus+ programme: Dům zahraniční spolupráce, Na Poříčí 1035/4, 110 00 Praha 1 :
a) for the purpose of evidence of participation in mobility, requested for exploitation of grant budget in the programme Erasmus+, in the form of „List of
participant“, there will be following data provided: First name and surname, e-mail address, sending organisation, country.
b) for the purpose of evidence in online system of European commission https://webgate.ec.europa.eu equested for exploitation of grant budget in the
programme Erasmus+, there will be following data provided: First name and surname, date of birth, sex, e-mail address, sending organisation, country.
VI. Content period for processing and keeping personal data is provided for an indefinite period till the withdrawal, excluding photographs and video
recordings, that will be processed for an indefinite period without the possibility of withdrawal. Another personal data will be processed for the period
necessary for administration guiding in the connection with exploitation of grant budget from the programme Erasmus+. After that they will be shredded
and deleted.
VII. Data subject is allowed at any time to cancel his/her content with personal data processing, also is allowed to request from the Data administrator
the access to his/her personal data, its correction or deleting, or to restrict the processing, and to raise an objection against processing, is also allowed to
transfer those data to another Data administrator, or is allowed to complain to the Office for personal data protection, in case of any doubts, that Data
administrator while processing personal data proceeds contrary the Regulation. The only exception is for already processed photographs or video
recordings, used for visibility or dissemination within the educational event and for visibility of Administrator. Video records and photographs already
published cannot be deleted.

Date: Signature: ______________________