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Europatouren: Grenzenlos 2011 | Rotex1900 e.V.

/ The-Taste-Of-Europe 2011 | D-1900

ROTARY INTERNATIONAL

Y out h Exchange P rogram m e


Di str ict 1 9 0 0
Inbound Chai r
Frank Bisterfeld, RC Meinerzhagen, Bordinghausen 3, 58566 Kierspe,
E-Mail: fam.bisterfeld@t-online.de, Tel. +492359-1504

Applicant & Parent Permission Form (APPF)


-Heimatland-

THE UNDERSIGNED APPLICANT _____________________ and the undersigned parents or Guardians of the applicant
hereby agree the applicant can be permitted to travel to another country such as Belgium, France, Italy, Czech Republic,
Hungry, and Austria and live in host families, hotels, hostels and camping-grounds as a participant of the the Grenzenlos
2011 – Rotex 1900 e.V. European Tour / The- Taste-Of-Europe 2011, the Rotary European Tour 2011.

IN CONSIDERATION of the acceptance of the applicant in such Program, the undersigned APPLICANT and his or her
PARENTS or GUARDIANS, to the full extend permitted by law, hereby release and agree to save, hold harmless and
indemnify all host parents and members of their families, and all members, officers, directors, committee members and
employees of the host and sponsoring Rotary Clubs and districts, Rotex 1900 e.V., and of Rotary International, of and from
all liability for any loss, property damage, personal injury or death, including any such liability which may arise out of the
negligence of any of such persons or entities, which may be suffered or claimed by such applicant, parent or guardian
during, or as a result of the participation by the applicant in the Grenzenlos 2011 – Rotex 1900 e.V. European Tour / The-
Taste-Of-Europe 2011, the Rotary European Tour 2011, including travel to and from the host club in Germany.
WE GIVE PERMISSION for any operation, anaesthesia or blood transfusion which a medical practitioner may deem
necessary or advisable for the treatment of any illness or injury suffered by the applicant.
WE AGREE that one of the responsible TourGuides of the European Tour, may sign on behalf of the applicant and his or her
parents or guardians any and all medical emergencies release documents for such treatment.

WE ASSURE, that _____________________ will have a health- and accident insurance during the Tour valid in all the
countries mentioned above.
WE GIVE PERMISSION for our daughter/son to participate swimming in the Mediterranean Sea and Atlantic Ocean and
walk around in groups with at least 2 other participants when allowed by TourGuides in major European cities and all along
the Tour route.
WE AGREE that the APPLICANT ___________________ , even if she/he is or turns 18 years during the Tour, at ALL
TIMES stands under supervision of the TourGuides and respects given orders and rules.

WE ALSO AGREE that ____________________ will stay under Rotary International Exchange Rules and especially not
take any drugs, not drive any motorized vehicle nor have any sexual contact with another exchange student or any other
people along the Tour route.

WE CERTIFY that we have been informed that the tour will cost around 1200- 1350.- €, roughly US$ 1670- 1800(Stand:
08.11.2010) and that we will pay the money. There is existing a deposit of 450 € which has to be paid by each participant
th
until the 30 November. This also functions as a security for a later deregistration. In this case the amount of money will
not be paid back. The remaining amount has to be paid by December 31st. If the undersigned applicant ignores
supervision or the rules set by the TourGuides, she/he will be immediately sent home on her/his own costs and risks. As
soon as the Tour has ended for the applicant through his/her fault or not, only actually not arisen costs will be refunded.

Date/Place Signature of Father/Guardian Date/Place Signature of Mother/Guardian

The remaining amount has to be paid by December 31st

Host Club:
RC_________________________________

Grenzenlos 2011 | Rotex 1900 e.V. / The-Taste-Of-Europe 2011 | D-1900 || Applicant & Parent-Permission Form-Heimatland
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