<p> AUSTIN-KOBLENZ STUDENT EXCHANGE EMERGENCY CARE / MEDICAL RELEASE FORM June 2016</p><p>Participant’s Name ______Birthday: ______dd / mm / yy Please supply the following information: Emergency numbers: Home: ______</p><p>Office: ______</p><p>Other: ______</p><p>List medications and prescriptions participant needs:</p><p>______</p><p>______</p><p>List medications and prescriptions to which participant is known to be allergic:</p><p>______</p><p>______</p><p>HEALTH INSURANCE: For travel overseas, most health plans do not provide coverage, and the ones that do often require you to pay for services up front and reimburse you only after you return home. Even if you plan does cover overseas treatment, most out-of-country hospitals make you pay your bills upfront, and then send you a refund after you’ve returned home. As a safety net, you may want to buy travel medical insurance. </p><p>MEDICAL RELEASE: In the event the above-named person is unable to make rational decisions about immediately needed medical care, the teacher-chaperones have permission to make those immediate decisions. The teacher-chaperones are released from liability for medical decisions made during the student exchange trip.</p><p>______(student signature) (parent signature)</p><p>______(date: dd-mm-yy) (City, State) AUSTIN-KOBLENZ STUDENT EXCHANGE BEHAVIOR CONTRACT June 2016</p><p>1. I am and will be polite, friendly, thoughtful, helpful, and open-minded during my stay in Germany. 2. I will follow the rules set by my host family during my stay, including any curfew they may require. 3. I will not smoke, drink any alcoholic beverages, or use any illegal drugs during the exchange trip.* 4. I will participate in all exchange activities. 5. I will not drive any motor vehicle during my stay. 6. I will not date during the exchange trip. 7. I will not obtain any body piercings or tattoos during the exchange trip. 8. I know that the consequences for breaking any items of this contract will result in the following: A. My teacher-chaperone will call my parents in the USA, and my parents will pay for that call, OR B. I will be sent home to Texas, and my parents will pay the cost of any phone calls and/or extra travel expenses. 9. I understand that this exchange and this trip will be an enlightening experience for me. I also understand that my teacher-chaperone is not a police woman and that she has no desire to follow my every footstep. I will try to behave my best at all times during the trip. 10. I know that I am to take care of my personal belongings, especially my passport, train, subway, and bus tickets, and my spending money. My teacher-chaperone cannot be held responsible if any of these are lost or misplaced.</p><p>The chaperone of the Austin-Koblenz Student Exchange has the right to decline a student’s participation in the exchange at any point if the chaperone has reasonable doubt that the student will be able to handle the responsibility of traveling internationally. Please note that once payments have been made that a refund will not be possible. </p><p>______(student signature) (parent signature)</p><p>______(date: dd-mm-yy) (city, state)</p><p>*Carrying or using illegal drugs in all foreign nations is an offense that is punished by immediate imprisonment. My teacher-chaperone cannot be responsible for helping any student who so violates the law. Even consular intervention will not bring about release of the offender. Required medication should be prescribed by a doctor and properly labeled.</p>