Parental Travel Consent Form
Exchange Program
Name of Student
Date of Birth
Passport Number
Exchange Program Details
Destination Country and Address
Travel Dates (Departure and Return)
Name(s) of Accompanying Adult(s) / Guardian(s) (if any)
Name(s) of Parent(s) / Legal Guardian(s)
Parent(s) / Legal Guardian(s) Contact Information
Consent Statement
Signature of Parent/Guardian
Date
Signature of Parent/Guardian
Date