WGC International - Student Travel Request Form

Student Name

Homestay Parents

Travel Commencement Date:
Date leaving homestay accomodation

Travel Completion Date:
Date returning to homestay accomodation

Please include details of cities/ places to be visited and the complete address and phone number for accommodation or Travel Company you are travelling with

Travel companions/ chaperones (include names of all other parties or groups accompanying the international student on this trip):

Name, Age, Relationship to Student

In the event of injury or death of my child as a consequence of the practice of any the above mentioned activities, I understand that:

Such event might not be covered by my child’s insurance policy;
I hereby accept all responsibilities, including financial ones, which may be related to such an event.

Student's Parent's Signature
If you are on a desktop or laptop you can sign with your mouse. If you are on a tablet or mobile device you can sign with your finger.

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Student's Parent's Name

Date