Travel Permission – Rocky Mountain Rotary Youth Exchange

Request an electronic copy of the Travel Permission form

Complete this online form to receive a copy of the travel permission form emailed to all parties who will need to sign it.

All fields below are required.

Submitting this web form is not permission to travel. All parties must complete the Travel Permission Form which is emailed after submitting this web form prior to traveling.

If you have not started this process and the trip is in the next 4 days, you will likely not be able to travel. This is not an automated process. It will take 2-4 days for the initial travel form to be sent out for signature.

If you are traveling outside the US, there are additional steps that must be taken before you leave. Please allow at least 2 additional weeks for the additional paperwork if you are traveling internationally.

Belo Hawaii, Belo East Coast, or Belo West Coast Trips:
If you are traveling with Belo USA on a Rotary trip: you will complete their travel form, not this travel form. Do not submit this travel form if you are traveling on a Belo trip.

Request an electronic travel form

Request travel permission form – need student emails, parent emails, host family emails

Step 1 of 2

Student's Home Country*
Student's Host Club*
Current Host Family:*
Current Host Parent Phone number*
Please put the phone number of one of your current host parents.
Today's Date*
MM slash DD slash YYYY
Travel Start Date*
MM slash DD slash YYYY
Travel End Date*
MM slash DD slash YYYY
State (or states) you will be visiting*

If you are planning to leave the US, please list the name of the country or countries you will be visiting. Please note, we must amend your J-1 form if you leave the US. This requires additional lead time & paperwork. Please notify your country contact of these travel plans immediately.
Please describe the trip below.*
Include a short summary of the trip. Please include specific details on where you’ll be staying, include phone numbers & any other relevant details)
Will you be traveling with your host family?*
- Yes
- No
If you are not traveling with your host family, please list the full names, phone numbers & how you know the adults below.*
ex: is this a school trip & the person in charge is a teacher or coach? are you traveling with a Rotarian from your club? Are you traveling with another exchange student & their host family? etc.
Will you be missing school?*
- Yes
- No
School Contact's Name*
School Contact's Phone Number*
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Has anyone already signed an old version of the travel form?
- Yes
- No
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If yes, upload the signed document below & list the remaining signers full names & email below:
Required: Natural Parents, Host Parents, Youth Exchange Officer & Kimberly Armitage
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File
Max. file size: 100 MB.

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Release and consent by Student and his/her Parents or Legal Guardians and RMRYE*
We the parents or legal guardians of the Rotary Youth Exchange Student shown above give permission for him/her to travel to the destination shown above, at (and only at) the time shown above, with the other travel arrangements, such as companions and host shown above. We agree that either the student or we will pay all expenses for that travel. In consideration for Rotary’s granting permission to travel to the student named above, we the parents or legal guardians and the student, to the full extent permitted by law, hereby release and agree to hold harmless and indemnify all host parents, members of their families, all members, officers, directors, committee member and employees of all host and sponsor Rotary Clubs, Districts and organizations, Rocky Mountain Rotary Youth Exchange and Rotary International, of and from all liability or any property loss, property damage, personal injury or death, including such liability which may arise out of the negligence of any such persons or entities which may be suffered or claimed by the student, parents or guardians during the period of his/her travel, including travel to and from the destination described above, or elsewhere, expressly waiving any and all claims for liability which we or any of us assert. Student agrees not to deviate from stated travel plans without first informing RMRYE and further agrees to not participate in any activity not covered by their insurance. We further understand that if such travel is to occur following the student’s exchange year, the permission and release shall apply to any and all travel thereafter, including travel from the host town, it being understood the student is no longer under the auspices of the Rotary International Youth Exchange Program and is traveling as an individual without the sponsorship of Rotary International, host and sponsor Rotary Districts, host and sponsor Rotary clubs, without Rotary sponsored insurance and without a Rotary sponsored visa.
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We have read all of the above and agree to these terms and restrictions:
Student's Name*
First Last
Student Email*
Student's natural parent 1*
First Last
Natural Parent 1 email*
Student's natural parent 2*
First Last
Natural Parent 2 email*
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Having read all of the above information and seeing the legally binding signatures of the student and his/her parents or legal guardians, properly dates, whereby they agree to the terms and limits set forth, we do hereby give our permission to the student for him/her to travel as specifically set forth above (and only as set forth above)
Current host parent 1*
First Last
Current host parent 1 email*
Current host parent 2*
First Last
Current host parent 2 email*
Club Youth Exchange Officer name*
First Last
Club Youth Exchange Officer email*
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District Official
First Last
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District Official's email

Request an electronic copy of the Travel Permission form

Request an electronic travel form

Step 1 of 2

We have read all of the above and agree to these terms and restrictions: