Inbound Permission To Travel Form
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2Rotary District 7210 YEX Inc.
Inbound Permission to Travel Form
Travel is permitted with host parents or on Rotary authorized functions with proper adult chaperones.
Other travel must be approved by your Host Club Youth Exchange Officer, Host Family, and the Youth
Exchange Committee. Extended or distant trips will also require the permission of the student’s own
parents in writing, exempting Rotary of responsibility and liability. Students may not travel alone or be
accompanied only by other students. A complete itinerary should be given to the Youth Exchange
Officer and the Youth Exchange Committee. District 7210 has an obligation to be able to reach any
inbound student within 24 hours should the need arise. There is no intent to make it difficult for host
families to take their exchange students on trips with them; however, it is necessary to keep the Youth
Exchange Officer and the YEX Committee informed if they plan to be out of town for more than one
night. If the Youth Exchange Officer is away or unavailable the information should be provided to the
Hosting Club President as well as the YEX Committee. Use of this form is not required for weekend
events sponsored or authorized by Rotary District 7210, or for incidental travel with the host family or
club, provided the YEO has pre-approved plans; such travel is covered by the Permission to Travel
form signed by the student’s natural parents. Use this form for travel out of state, extended trips or
travel with someone other than the host family.
Please complete all sections that are applicable.
Student Name: ________________________________ Host Family Name: _____________________________
Address:____________________________________________________________________________________
Street
City
State
Zip
Phone: (
)_____________________________ Email: ____________________________________________
Departure Date: ______________________________ Return Date: ___________________________________
Purpose of Trip: _____________________________________________________________________________
Will the student be missing school?
____ Yes
____No
If yes, how many days? _________
Destination/itinerary (including dates if student will be traveling to more than one location):
Date
Name of family, hotel, camp, etc
Address including City/State
Phone # & e-mail
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________________
Name of adult chaperone(s) and contact information:
___________________________________________________________________________________________
If traveling by plane, train, bus or other commercial carrier
Name of carrier:______________________
Flight or Route# ______________________
Return trip:__________________________
Flight or Route# ______________________
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