AUTHORIZATION FOR ROTARY TOURS IN BRAZIL
It is understood and agreed by the students and the student’s parents that neither any Rotary Club or Rotary Organization, nor the
Tour Committee will be responsible for injury through mishap to any student or staff member accompanying the tour. EACH
STUDENT MUST HAVE HIS OWN HEALTH & ACCIDENT INSURANCE. Moreover, any Rotary Club, Rotary Organization, and
the Tour Committee are hereby expressly released from any and all liability for any damage, death or injury which the student
might suffer while taking part in the tour, both as to any right of action that might occur to the student or the student’s relatives,
executors or assign. The undersigned student and his (her) parents further agree to indemnify and save harmless any Rotary Club
or Rotary Organization, and the Tour Committee from any and all claims of costs, including, but not limited to counsel fees and
counsel costs that may arise any injury death damage to any student while on the tour.
A) ACCEPTANCE OF TERMS AND PERMISSION FOR THE TOURS
A.1) I hereby agree with the terms above for all the tours organized by Belo Brasil Tours (Mr. Bernardo Gontijo) and committee for
Rotary Exchange Students I take part during my exchange year in Brazil.
24 25 -
Year: ___________
4640
Rotary district # in Brazil: _______________
4648
Rotary district # in the student’s country: ___________________
Student’s country: ____________________
Student’s Signature and Name: ____________________________________________________
Signature
Date: ____/____/____ ___________________________________________________
Full Name
A.2) I hereby agree with the terms above and give permission to my son/daughter to travel to all tours organized by Belo Brasil
Tours (Mr. Bernardo Gontijo) and committee during the exchange year.
↑
A.3) I hereby agree and give permission to my son/daughter to participate of all the activities included on the Trip Program offered
by Belo Brasil Tours and committee during the exchange year.
A.4) I hereby agree and give permission to my son/daughter to stay at hotels and inns provided during the trips by Belo Brasil
Tours and committee during the exchange year.
A.5) I hereby agree and give permission to my son/daughter to participate of Tours by Night (Restaurants, Folkloric Shows, Soccer
Games, Parties and others) included on the Trip Program offered by Belo Brasil Tours and committee during the exchange year.
P
Parents or Guardian’s signature:
Fr
Father: ___________________________________ Mother: _________________________________
Signature Signature
Mao weihna
______________________________________
,
TAN CHIAWEN
_________________________________
,
Full Name Full Name
12 09 24
Date: ____/____/____
1 - This document has to be signed by your parents from your original country.
2 - This document has to be sent by email to Belo Brasil Tours – intercambio@[Link]
HEAD OFFICE: Av. Afonso Pena, 4273 / Pilotis – Mangabeiras – Belo Horizonte / MG – Brazil - 30130-008
Phone + 55 (31) 3282-2080 - intercambio@[Link] - [Link]
