Travel Permission

Student Personal Details

Name*

FirstLast

Date*

Today's Date

Your Location*

Your request will be directed to your local support team!

Date of Birth -mm/dd/yyyy*

Your Gender*

Male
Female

High School*

What is your current grade in school?*

American Home Address*

Street AddressAddress Line 2CityStateZip Code

Student's Email*

Student's Cell Phone*

Host Family's or Guardian's name*

FirstLast

Host Family's or Guardian's Phone*

Family Information

Parent's Name*

FirstLast

Parent's Email*

Parent's Phone*

Medical History

Medical Insurance Company*

Insurance Policy number*

Do you take any medications, vitamins or herbal remedies?*

Yes
No

If "Yes" describe what you take and how often:

Do you have any allergies or chronic illnesses?*

Yes
No

Do you have any dietary restrictions?

If "Yes" list allergies or chronic illnesses:

Trip Details Section

Where are you traveling to?*

Description of travel*

List what are your travel plans and with whom will you be traveling.

Departure Date*

Return Date*

Mode of Transportation*

Flights outside of the US will require update of I-20. Hotels and transportation should not be booked until travel is approved!

Airport *

Logan
Bradley
JFK ($300 additional transportation charge each way)
Newark Airport ($350 additional transportation charge 1 way)
Philadelphia (New Jersey Students)

Guardian for Trip (Responsible Adult Over 21 Years Old)

Guardian must be willing to accept written responsibility for student!

Name*

FirstLast

Relationship to student*

Guardian's Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone*

Guardian's Email*

Application completed by:*

This travel is subject to acceptance of our terms and agreements. I agree to authorize this trip by phone or email as a substitute for my signature if the travel is acceptable. We, the parents of the above named student, give our child permission to travel without an IBG Representative for the event listed below. We understand that any unsupervised travel contains an element of risk, assume all risks and hazards associated to such participation and do hereby release, absolve,indemnify and agree to hold harmless all IBG Representatives any and all liability that may arise out of participation in this event. We also give consent for emergency medical treatment if necessary and understand my child must carry his/her Passport, Medical Card and a copy of this Authorization with them at all times during the travel of my child. As parents, we remain fully responsible for any legal ramifications, which may result from any personal actions taken by the named child, and hold our child to the highest level of professionalism expected from IBG while he/she is traveling outside of the program.*

I accept the terms

Travel Permission