Homestay Program Minor Consent Application
Student Information
Student Full Name
Date of Birth
Nationality
School/Institution
Homestay Address
Parent/Guardian Information
Parent/Guardian Name
Relationship to Student
Contact Number
Email Address
Home Address
Medical Information
Does the student have any allergies or medical conditions?
Medications (if any)
Emergency Contact (Name & Phone)
Consent & Agreement
I, the parent/guardian of the above-named student, give consent for participation in the Homestay Program and authorize the homestay host and program staff to act in case of emergency.
Parent/Guardian Signature
Date