We have received your enrollment form.
We will send you an email to confirm your registration .
The following data were recorded:
Name : $in{element_6_2} First name : $in{element_6_1}
Address : $in{element_2_1}    City$in{element_2_5} $in{element_2_3}  $in{element_2_6}
Date of birth : $in{element_7_1}/$in{element_7_2}/$in{element_7_3} Tel.: $in{element_3}
Email : $in{MAILFROM}
School : $in{element_10}  $in{element_11} Class : $in{element_12} Section : $in{element_13}
Hours/week. : $in{element_14}
Results : $in{element_21}

I hereby, $in{element_1_1} $in{element_1_2} want to enroll my daughter / my son
for a course $in{element_19} starting : $in{element_8_1}/$in{element_8_2}/$in{element_8_3} for a period of $in{element_15} weeks in  Formula : $in{element_20}

Optie : $in{element_17_1}

I have read en accept the Terms & Conditions

Communication : $in{element_16} 

If these data are not correct, you can always make corrections using the "Back" button on your browser.

Yours sincerely,
Kasteel van Velm