I, ___________________________________________, the parent of ________________________________________ give permission to the group leaders of this trip, and to my child’s host family, to authorize emergency medical care and treatment for my child while travelling in Austria on a cultural exchange program with Euro-American Student Alliance. I verify that our family subscribes to an insurance policy that provides appropriate medical and liability coverage, and that the host family, group leaders, travel agency, and/or exchange program organization will not be held liable for any costs resulting from illnesses, accidents or travel delays and other incidents which occur outside the terms of the insurance coverage. Our family understands that Euro-American Student Alliance, and its partners will do everything possible to ensure a safe and positive travel experience for my child. _____________________________________________ Signature of Parent ___________________Date EURO-AMERICAN STUDENT ALLIANCE RELEASE FORM

Insurance Company: ______________________________________ Policy Number/Group Name: _______________________________ Phone Number: _________________________ Physician’s Name: ________________________________________ Phone Number: __________________________ 800-numbers are not usable overseas; please include area code with phone numbers)800-numbers are not usable overseas; please include area code with phone numbers) Listed below are the daytime phone numbers for the parent(s) and also the name of an emergency contact and phone number, should the parents be unavailable. Student’s Name: _________________________________________ Home Phone Number: ____________________________________ Father’s Name: _________________________________________ Daytime Phone Number: ___________________________________ Mother’s Name: __________________________________________ Daytime Phone Number: ___________________________________ Emergency Contact’s Name: ________________________________ Daytime Phone Number: ___________________________________ Relationship to the Child: __________________________________ My child is taking medication known as _________________________________ for the treatment of _______________________________, and has a doctor’s note certifying the use of this medication. EURO-AMERICAN STUDENT ALLIANCE INSURANCE, PHYSICIAN & PRESCRIPTION INFORMATION

While participating in this exchange program, American teens are expected to display excellent behavior and to be courteous to their host families, group leaders and tour guides. The student understands that they are to act as a member of their host family and to offer help with any household chores. The American teen agrees to notify and seek permission of their host family of any extracurricular activities being planned outside of the scheduled program before making plans with others. The American teen also agrees to make only collect calls or use a prepaid phone card when calling home to America, and will not leave his/her host family with any long distance charges on their phone bill. I understand that by participating in this cultural exchange program that I am acting as ambassador of this country and that my behavior will be the barometer in which my foreign hosts will regard all American teenagers. _______________________________________ Signature of American Teen EURO-AMERICAN STUDENT ALLIANCE CODE OF CONDUCT