DQMF Travel Form

TRAVELLING INFORMATION

Name:*
Age:*
Contact Number:
-
E-mail:*
Traveling From:*
Need airport pick up?(Only if under 18 years old):*
Arrival Airline:
Arrival Date:
 / 
 / 
Arrival Time:
 : 
 : 
Returning Date:
 / 
 / 
Need airport drop off?(Only if under 18 years old)
Contact in case of emergency:*

STUDENT RESPOSIBILITY

I understand that I am required to attend camp regularly and give my best efforts*
I agree to accept decisions in by best interest by my host family and Dali Quartet International Music Faculty*
I agree that I will not use any illegal drugs, be in possession of drugs or have close relationships with others who use drugs*
I agree that I will not drink alcoholic beverages*
I agree that I will not drive a car, motorcycle or other vehicle which requires a license if I'm under 21 years old*
I understand that I am not permitted to hitchhike while I am an exchange student.*
I understand that I am not permitted to have any job which would require regular hours of employment away from my home*
I agree to abide by decisions made on my behalf by the Dali Quartet International Music Festival Faculty and host family*
I will not apply for a license to hunt nor will I engage in using a firearm*
I understand that it is a primary responsibility to inform the Dali Quartet International Music Festival Faculty of the host country of plans to travel with my host family or school group to assure contact at all times*
I understand that the Dali Quartet International Music Festival Faculty reserves the right to impose restrictions or forbid such travel*

PARENT RESPONSIBILITY 

(TO BE FILLED BY PARENT/GUARDIAN IF STUDENT IS UNDER 18 YEARS OLD)

I give permission for any medical or surgical care which should be necessary in case of emergency*
I will arrange for my son/daughter to have all necessary dental work done before leaving the country*
I will arrange for my son/daughter to have health and accident insurance coverage for the duration of the time that he/she is abroad*
I understand that my son/daughter is not permitted to drive and automobile or any motorized vehicle while he/she is an exchange student. I also understand that my son/daughter is not permitted to hitchhike while he/she is an exchange student – nor use a firearm*
I understand that the Dali Quartet International Music Festival Faculty will arrange transportation and orientation for the exchange student and that my son/daughter will travel to and from the host country at the times so arranged*
I agree that my son/daughter will abide by decisions make on his/her behalf by the Dali Quartet International Music Festival Faculty*
I understand that trips not sponsored by the Dali Quartet International Music Festival or not in the company of the host family, can only be undertaken by my son/daughter with my written permission and the agreement of the host family and the Dali Quartet International Music Festival, after notifying well in advance of the trip*
I understand that the Dali Quartet International Music Festival reserves the right to impose restrictions or forbid such travel*

STUDENT HEALTH INSURANCE INFORMATION

Parent/Guardian Name:*
Health Insurance Company:
Policy Number:
Effective Date:
 / 
 / 
Insurance coverage under the name of:

Record of Noncommunicable Disease or Condition

Asthma*
Diabetes:*
Epilepsy:*
Hay Fever:*
Allergies:*
If yes, indicate type of allergy:
Are you vegetarian?:
Special Needs/Comments:
By signing your initials, you agree to all the terms and conditions expressed above. *