MINISTRY OF EDUCATION AND SCIENCE MINISTRY OF EDUCATION AND SCIENCE RUSSIAN FEDERATION RUSSIAN FEDERATION FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION ARTEK INTERNATIONAL CHILDREN’S CENTER ARTEK INTERNATIONAL CHILDREN’S CENTER

FGBOU Artek ICC, 41 Leningradskaya Street, , Municipality, FGBOU Artek ICC, 41 Leningradskaya Street, Gurzuf, Yalta Municipality, Republic of , 298645 Republic of Crimea, 298645 Russia

PUTYOVKA VOUCHER Session # ______Series _____ Number ______Session # ______Series _____ Number ______

Date: from «_____» ______201___ to «____» ______201___ Date: from «_____» ______201___ to «____» ______201___

Child information (please print) Child information (please print)

Surname Surname First name First name Middle name Middle name

Date of birth ______Date of birth ______

PARENT’S NAME ______PARENT’S NAME ______(or name of legal guardian) (or name of legal guardian) ______

Address of parents or legal guardian______Address of parents or legal guardian______

As part of state order/service agreement As part of state order/service agreement Amount in word ______Amount in word ______

Nominated by: Organization that issued this voucher ______Stamp Stamp Director ______Signature ______Information for Parents Terms of child’s stay at the Center (important information)

FGBOU Artek ICC accepts children only on and between the dates specified on this During their stay at Artek ICC, the children are provided with a uniform for the season voucher. (except for underwear, shoes, and headgear). The center assumes the responsibility for the safety of things and gadgets deposited in Documents confirming the child’s right to receive this voucher (child’s portfolio) tobe the storage room of each camp. Children can visit the storage chamber during working hours. submitted to the Artek ICC include: The money the children have on them is deposited in the child’s personal account at 1. Application from the parent (legal guardian) for enrollment in a training program at Artek the cash department and issued on request. The amount of money allocated to children is ICC. determined by their parents, based on the cost of souvenirs and travel. 2. Two copies of the child’s birth certificate or passport. In the event of a child’s early departure from FGBOU Artek ICC, the remaining cost of the 3. Medical file of approved format (the form is available from the center’s official website, voucher cannot be returned. Artek.org, in the Information for Parents, Medical Requirements section), with the physician’s The center has the right to terminate the child’s stay in the camp ahead of schedule and conclusion about the state of the child’s health and any medical contraindications to any Artek send them home for gross violation of the rules, namely: the child commits acts and deeds activities, issued by a medical institution no more than 10 days before the child leaves for that offend or humiliate another person, harm their own or others’ health, tobacco smoking, the Artek ICC. Children who have medical contraindications or any form of pediculosis (lice drug abuse, using psychotropic substances, alcohol, including beer. infestation) will not be admitted. Parents (legal guardians) agree with the child’s involvement in the educational, sports, 4. Parent’s/legal guardian’s informed voluntary consent to medical intervention. tourist and other events organized at the Center within the approved program of the relevant 5. Physician’s certificate, proving no contact with contagious diseases, issued not earlier session. To increase the child’s interest in the activities, the parents agree on the possible than three days before the child’s departure to the Artek ICC. restriction of the child’s access to the use of mobile devices, as well as access to the Internet 6. Copy of medical insurance policy. and other entertainment applications. 7. Application Form No. 5 (for submission to the Federal Migration Service). The form is Parents (legal guardians) agree that for the sake of health, safety and well-being of all available on the website www.artek.org in the Information for Parents − Documents for Artek children and employees of the camp, the child must comply with the rules and standards of section. conduct of FGBOU Artek ICC. The child should have seasonal outerwear and shoes, underwear, a tracksuit and training Parents (legal guardians) agree to participate in interviews, photos and video shoots, and shoes, headgear, toiletries, writing material (during the school year), and pocket money for also allow editing and use of photographs and video footage for non-commercial purposes, personal expenses. including print production, publication of photos on the Internet on the official Artek website During the stay at the Center, every child is required to observe the following rules: and other media. • Follow the established daily routine, general sanitary and hygienic standards (wash, Parents (legal guardians) give their consent to hospitalization, emergency surgical brush hair, shower, dress according to the weather, wear sunblock, etc.). treatment, or other emergency medical intervention necessary to save the life and health of a • Comply with all established rules, including fire safety rules, the rules of bathing in child in the event of life or health threatening conditions. the sea, excursions, hikes, and bus trips spelled out during your counselor’s briefings. • Observe personal safety rules, do not commit acts that might harm your own and others’ health. I HAVE READ AND DISCUSSED THE ABOVE INFORMATION WITH THE ABOVE • Do not cause moral or physical harm to other children, including through extortion, MENTIONED CHILD AND HEREBY GIVE MY FULL CONSENT FOR THAT CHILD TO STAY threats, theft, and deception. AT THE CENTER UNDER THE ABOVE MENTIONED TERMS. • Do not use physical force in arguments. • Observe the rules of conduct in public places. Signature parent/legal guardian • Do not use obscene language. • Do not smoke, do not drink alcohol (including beer). • Do not take any medication without adult consent or narcotics. • Stay with your group. Do not leave the camp. ______• Respect the gardens, keep the area clean. (Signature) Name (block capitals) • In case of health problems, inform your counselor immediately. • Take care of your personal property and the property of the camp. • Make your bed, keep your personal belongings in order. • Inform the counselor about household malfunctions. ATTENTION: Without a signature, the administration of the center has the right to • Observe the tradition of Artek − wear Artek’s uniform. decline the child’s admission! • Keep valuable things and money in the storage room with the camp cashier.