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Destinations
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DISCHARGE OF RESPONSIBILITY FOR MINOR CHILD & ACKNOWLEDGMENT OF RISKS
Student Details
Student Name
Student Surname
Date of Birth
Parent Name
Parent Surname
Parent Email
Parent Phone
Medical Details
Does the student suffer from any medical conditions/allergies/physical limitations?
Yes
No
If yes, please elaborate:
Does the student require any medical treatment/medication?
Yes
No
If yes, please elaborate:
Does the student require a special diet for medical or religious reasons?
Yes
No
If yes, please elaborate:
Does the student suffer from an eating disorder?
Yes
No
Does the student suffer with mental heath difficulties?
Yes
No
If yes, please elaborate:
Curfew
Sunday - Thursday Curfew
I authorise my son / my daughter to go out on school days until ____________ (No later than 9pm)
Friday - Saturday Curfew
I authorise my son / my daughter to go out on weekends until ____________ (No later than 11pm)
I do not authorise my son /daughter to go out on school days.
I do not authorise my son /daughter to go out on weekends.
Any other information relevant to my son/daughter
I declare that I have read and accept the Tribe Study Abroad Terms and Conditions
*
Yes
No
