Parental Agreement

To be completed by the parent/guardian
Organizer to retain copy on file

Do not send to Experiences Canada
17. Parental Agreement
Group/Household Name : _______________________________________________________
Name of Participant : _____________________________________________________________
In signing this form, you are giving your permission for your child to participate
in EXPERIENCES CANADA Youth Exchanges Canada and agreeing to the conditions
of participation.
In consideration of my child's participation in EXPERIENCES CANADA Youth Exchanges

Canada, I agree to the following conditions:
I confirm that my responsibilities as a host parent have been explained to me. I

am willing to undertake these responsibilities and will provide a safe and secure
environment for the youth I will be hosting.
I agree to provide adult supervision and take full responsibility for our guest
while he/she is in my home and expect the host parents of my child to do the
same during his/her /they stay in the other province/territory.
I understand that in order to be able to host an exchange student, every adult

18 years and older living in the household during the exchange week must
provide a clear police record and vulnerable sector checks.
I understand that host family screening is mandatory for participation as a host

family in this EXPERIENCES CANADA exchange program and I will take part in
the specific procedures put in place by the Group Organizer and Experiences
Canada.
I will contact my child’s twin family prior to hosting to ensure that a safe and
respectful environment will be provided.
I authorize medical attention for my child if judged necessary by the medical

authorities of the host province/territory, the Group Organizer or the host family
in the case of an accident or serious illness. I understand that every attempt will
be made to reach me by telephone in case of an emergency.
I understand that my child (or myself) may have the opportunity to express
himself/herself verbally or in written form at any point during the exchange.
I understand that if my child does not respect the code of conduct previously
agreed to and if the Organizer deems his /her behavior unacceptable, he/she
may be asked to leave the program and may be sent home at my risk and cost.
Parental Agreement June 2023 1|2
To be completed by the parent/guardian
Organizer to retain copy on file
Do not send to Experiences Canada
In this event, I hereby release and discharge and further agree to indemnify
EXPERIENCES CANADA, its employees and agents from all costs and risks
incurred in returning my child home from the moment of withdrawal, and from
all claims which may hereafter be brought against any of them by me or on
behalf of my child as a result of such withdrawal. I assume financial
responsibility for any cost my child may incur.
I understand and agree that, if I cancel my child’s participation in the

EXPERIENCES CANADA exchange that I am financially responsible for the
associated costs.
If I am unable to attend any of the group information sessions, I will make

arrangements to remain aware and maintain communication with the Group
Organizer (for groups)
I understand that EXPERIENCES CANADA does not permit any travel alterations.
All participants must accompany the group for the duration of the program
including departure and return travel. Individual participants must travel as
scheduled by Experiences Canada.
I understand, as a parent/guardian of a youth participating independently-

individually that it is my responsibility to bring my child and his/her twin when
they visit us to/from our local airport.
I understand that I must follow public health protocols and refer to Public Health
for up to date information in my community and in my child’s twin community.
I agree that it is my responsibility to complete the Exchanges Canada parent

survey online once the exchange is completed. The parent survey URL link will
be sent to me after the end of the exchange.
Please note that Exchanges Canada values your input and the parent surveys
are used to evaluate and improve the program for future Exchanges Canada
participants. Your answers are anonymous and kept confidential.
_______________________________________________ _________________________
Signature of Parent(s)/Guardian(s) Date
Parental Agreement June 2023 2|2

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Parental Agreement

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To be completed by the parent/guardian

Organizer to retain copy on file

17. Parental Agreement

Group/Household Name : _______________________________________________________

Name of Participant : _____________________________________________________________

In consideration of my child's participation in EXPERIENCES CANADA Youth Exchanges

I confirm that my responsibilities as a host parent have been explained to me. I

I understand that in order to be able to host an exchange student, every adult

I understand that host family screening is mandatory for participation as a host

I authorize medical attention for my child if judged necessary by the medical

I understand and agree that, if I cancel my child’s participation in the

If I am unable to attend any of the group information sessions, I will make

I understand, as a parent/guardian of a youth participating independently-

I agree that it is my responsibility to complete the Exchanges Canada parent

Parental Agreement June 2023 2|2

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