I, ___________________________________________, the I, ___________________________________________, the parent of ________________________________________ parent of ________________________________________ give permission to the group leaders of this trip, and to my give permission to the group leaders of this trip, and to my child’s host family, to authorize emergency medical care and child’s host family, to authorize emergency medical care and treatment for my child while travelling in Austria on a cultural treatment for my child while travelling in Austria on a cultural exchange program with exchange program with Euro-American Student Euro-American Student Alliance.Alliance.

I verify that our family subscribes to an insurance policy that I verify that our family subscribes to an insurance policy that provides appropriate medical and liability coverage , and that provides appropriate medical and liability coverage , and that the host family, group leaders, travel agency, and/or exchange the host family, group leaders, travel agency, and/or exchange program organization will not be held liable for any costs program organization will not be held liable for any costs resulting from illnesses, accidents or travel delays and other resulting from illnesses, accidents or travel delays and other incidents which occur outside the terms of the insurance incidents which occur outside the terms of the insurance coverage.coverage.

Our family understands that Our family understands that Euro-American Student Euro-American Student AllianceAlliance, and its partners will do everything possible to , and its partners will do everything possible to ensure a safe and positive travel experience for my child.ensure a safe and positive travel experience for my child.

__________________________________________________________________________________________Signature of ParentSignature of Parent

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RELEASE FORMRELEASE FORM

Insurance Company: ______________________________________Insurance Company: ______________________________________

Policy Number/Group Name: _______________________________Policy Number/Group Name: _______________________________

Phone Number: _________________________Phone Number: _________________________

Physician’s Name: ________________________________________Physician’s Name: ________________________________________

Phone Number: __________________________Phone Number: __________________________

•800-numbers are not usable overseas; please include area code with phone numbers)800-numbers are not usable overseas; please include area code with phone numbers)

Listed below are the daytime phone numbers for the parent(s) and also the name of Listed below are the daytime phone numbers for the parent(s) and also the name of an emergency contact and phone number, should the parents be unavailable.an emergency contact and phone number, should the parents be unavailable.

Student’s Name: _________________________________________Student’s Name: _________________________________________

Home Phone Number: ____________________________________Home Phone Number: ____________________________________

Father’s Name: _________________________________________Father’s Name: _________________________________________

Daytime Phone Number: ___________________________________Daytime Phone Number: ___________________________________

Mother’s Name: __________________________________________Mother’s Name: __________________________________________

Daytime Phone Number: ___________________________________Daytime Phone Number: ___________________________________

Emergency Contact’s Name: ________________________________Emergency Contact’s Name: ________________________________

Daytime Phone Number: ___________________________________Daytime Phone Number: ___________________________________

Relationship to the Child: __________________________________Relationship to the Child: __________________________________

My child is taking medication known as _________________________________My child is taking medication known as _________________________________

for the treatment of _______________________________, and has a doctor’s notefor the treatment of _______________________________, and has a doctor’s note

certifying the use of this medication.certifying the use of this medication.EU

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PRESCRIPTION INFORMATIONPRESCRIPTION INFORMATION

While participating in this exchange program, American teens While participating in this exchange program, American teens are expected to display excellent behavior and to be courteous are expected to display excellent behavior and to be courteous to their host families, group leaders and tour guides. The to their host families, group leaders and tour guides. The student understands that they are to act as a member of their student understands that they are to act as a member of their host family and to offer help with any household chores.host family and to offer help with any household chores.

The American teen agrees to notify and seek permission of The American teen agrees to notify and seek permission of their host family of any extracurricular activities being planned their host family of any extracurricular activities being planned outside of the scheduled program before making plans with outside of the scheduled program before making plans with others.others.

The American teen also agrees to make only collect calls or The American teen also agrees to make only collect calls or use a prepaid phone card when calling home to America, and use a prepaid phone card when calling home to America, and will not leave his/her host family with any long distance will not leave his/her host family with any long distance charges on their phone bill.charges on their phone bill.

I understand that by participating in this cultural exchange I understand that by participating in this cultural exchange program that I am acting as ambassador of this country and program that I am acting as ambassador of this country and that my behavior will be the barometer in which my foreign that my behavior will be the barometer in which my foreign hosts will regard all American teenagers.hosts will regard all American teenagers.

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Signature of American TeenSignature of American TeenEU

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ECODE OF CONDUCTCODE OF CONDUCT