Student Travel Request Form
This form must be completed every time you wish to travel for stays within our District or for travel involving overnight stays outside our District.
You must not presume that you may automatically travel – youmust receive written permission from your country coordinator.
Student Name Student email address Host Rotary Club Current Host Parents Name
Address Phone Number(s)
Host Parent's Agreement Signature
Club President's Agreement Signature
Host Club Counsellor's Agreement Signature
Host Counsellor's phone number Travelling with - School/Friends/Family Travelling to - Place/State Reason for Travel - Visit Friends/Holiday/School Commencement date of travel Return date of travel Mode of Travel - Car/Bus/Train/Plane
Flight Details Where Staying: Home/Resort/Hotel
Contact Numbers
Country Coordinator's Approval Name
Signature
Date
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