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PARENT Exchange Form

Select your school *

Student Information

Student Name *

Student Date of Birth * +

Current Grade in School *

Parent Name * 🛈

Phone Number *

Email Address *

Parent Name * 🛈

Phone Number

Email Address

Does the student have any allergies? *

If there are any allergies, please explain here

Does the student have any dietary or health concerns? *

Yes

No

If there are any special dietary or health concerns, please explain here.

Student Blood Type *

Please upload a copy of the student's passport ID page

Please upload a copy of the student's vaccination record

Please upload a copy of the student's most recent health/physical exam

Permission

If necessary, I grant permission for my son or daughter to receive emergency or medical assistance during the exchange program iin the case of an accident or unexpected event *

I grant permission for my son or daughter's image to be used for marketing purposes related to the promotion of future programs. *

I grant permission for my son or daughter to participate in any class, activity, or field trip organized on or off the school campus in the United States or in Spain for the duration of this exchange program. *

Liability Release Statement and Signature

Thank you to you and your family for your participation in our program and for taking the time to fill out this form.

With your signature below, your family indicates that you and your child are willingly taking part in this Exchange Program and that you waive Catholic Memorial School (Massachusetts), Mulhacen (Granda, Spain), and Campus Bridge International (Massachusetts) of any liability, damages, charges, costs, and/or causes of action for loss of property, personal injury, illness, accident, or death sustained by your child during the time that he/she is a participant in the program either in your home country or abroad.

You further agree to indemnify all of the above named from any and all liabilities, including liabilities to third parties.

Parent 1 Signature * 🛈

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Parent 2 Signature 🛈

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