Parental agreement

I, the undersigned,

First name Family name

Phone E-mail
Full Address

Hereby, declare that I understand and I agree that my son/daughter

First name
Family name

To participate in the ADVANCE PLANNING VISIT YOUNG AND YOU HAVE RIGHTS! (2016-3-RO01-
KA105-035438) implemented by Asociaia GENERATIA SCHIMBRII - AGES (Association
Generation of Change - AGES ) from Comneti, Romania between: 9th and 10th of May 2017 in Targu
Ocna, Romania.

To participate in the YOUTH EXCHANGE YOUNG AND YOU HAVE RIGHTS! (2016-3-RO01-KA105-
035438) implemented by Asociaia GENERATIA SCHIMBRII - AGES (Association Generation of
Change - AGES ) from Comneti, Romania between: 1st and 11th of August 2017 in Targu Ocna,
Romania.

Medical information about my child (allergies, special needs or requirements, food restrictions,
etc.:

I understand that during the project there will take place outdoor activities and I agree that my
son/daughter to participate in this activities. I agree that in any case of emergency to be contacted by
the group leader or the project responsible. I agree and I understand that I am full responsible of my
child acts. I understand that smoking, drinking alcohol or using any other forbidden substances are

Parental Agreement
KA1 - Youth exchange Programme countries
2016-3-RO01-KA105-035438
totally forbidden during the youth exchange and I discussed about this topic with my child. I declare that
I saw the Infopack with the full timetable and I agree that my child to participate in all the activities,
except:

I agree that my personal data, mentioned in this form, to be processed in accordance with
Regulation (EC) No 45/20014 of the European Parliament and of the Council of 18 December 2000
on the protection of individuals with regards to the processing of personal data by European Union
institutions and bodies and on the free movement of such data.

I agree that the photos and videos taken during the project (training sessions, study visits, Living
Library, or all the other activities related to the project) in which my son/daughter appear to be used
for the promotion of the project

Last but not least, I confirm that my personal data and all the content of this document are
according to the reality and I take full responsibility upon present statement.

Name Date (DD/MM/YYYY)

Signature Place (City, Country)

Parental Agreement
KA1 - Youth exchange Programme countries
2016-3-RO01-KA105-035438