PermissionforMedicalCareandRelease

1、Permission for Medical Care and Release未成年人治疗授权确认书Name of minor 未成年人姓名Date or last tetanus shot 破伤风注射时间Medication now being taken现所服用药物 Reason / 原因Dosage / 服用量Allergies / 过敏症Name of insurance company保险公司ID. or contract number证件号或合同号Name and phone number of family physician家庭医生姓名及电话号We, as the applic

2、ants parents or legal guardians, agree to authorize STS or the Host Family to act for us in any emergency, accident or illness during the period of time the student is involved in the STS Exchange program. This covers the period from the time the student boards transportation scheduled by the Progra

3、m until the student leaves the return-scheduled transportation by the Program.作为申请人的父母或法律监护人，我们同意STS机构或接待家庭在学生接受STS交换项目期间代理我们处理任何的紧急情况、突发事故或疾病。其中，交换项目的期限范围为项目行程的规定时间，即从学生出境时起到学生入境回国为止。. .Signature of Father or Legal Guardian Signature of Mother or Legal Guardian父亲或法律监护人签名 母亲或法律监护人签名Date . / . / .日期

4、Month Day YearRULES FOR STS STUDENTS学生准则1. Respect and uphold your Host Family regulations about curfews, household chores for which you are responsible, smoking and dating. Activities, including inviting guests to the Host Familys home, must be approved by your Host Family, and they must know where

5、 you are, with whom, and when you will return, at all times.尊重并支持接待家庭对学生宵禁时、所应承担的家务、吸烟及约会的管制。学生的任何活动，包括请人到接待家庭做客，必须经接待家庭的许可。任何时候，学生必须要让接待家庭知道你在哪、和谁在一起，以及何时回来。2. No drinking of alcoholic beverages including beer or wine. The only exception might be the occasional consumption of wine or beer in the Ho

6、st Family home with permission of the host parents.学生不准喝任何带酒精的饮料包括啤酒或红酒。在特殊场合下，学生只有经接待家庭许可，才可以在接待家庭喝啤酒或红酒。3. No drugs or association with anyone involved with drugs in any way. This includes the sale, possession, or being in the presence of others using drugs of any kind.学生不准吸食任何毒品或与吸食任何毒品的人有任何销售、占有

7、关系，或出现在吸毒者聚集的场合。4. No driving of cars or motorcycles is allowed at any time. 任何时候，学生不准驾驶汽车或任何的机动车辆。5. School attendance is obligatory. 6. STS students are not allowed to travel outside the local area either by himself or with other teenagers. The local area will be defined by the STS Area Representa

8、tive. Overnight travelling is allowed only with an approved group such as school or church sponsored group or with an adult person approved by the Host Family and STS. STS学生不能独自或随从其他青少年离开接待家庭到外省旅游。STS区域代表会对此负责。学生只许在接待家庭和STS机构允许的情况下并在成年人的监护下，才能与学校或教堂所组织的团队一起去通宵旅游。STS students are not permitted to vis

9、it their home country during their stay in the Host Country, with an exception of a serious medical emergency within the immediate natural family. Permission must be given by the STS Regional Coordinator or the STS National Office. STS学生不允许其在接待家庭期间回国访问，除非学生突然患有严重疾病且急需其父母的照顾，但必须经STS地方协调员及STS国家办公室的许可。

10、7. If the student travels outside the Host Country with his/her Host Family, he/she must first check at the border with Immigration Officials to be sure he/she will be allowed to re-enter.如果学生与他/她的接待家庭一起到境外去旅游，他/她必须先和边境移民局确定是否他/她可以再次返回接待国。8. Hitchhiking or soliciting a ride from a stranger can be da

11、ngerous and is prohibited.沿途搭载陌生人的顺便车具有危险性，禁止学生搭载。9. If an application is completed indicating the student to be a Non-Smoker, he/she must not smoke during the exchange program. Those who indicate that they smoke are expected to discuss their smoking habits with the Host Family and follow the establ

12、ished household regulations on when and where smoking is permitted.根据学生所填申请表，如果学生是非吸烟者，他/她在项目过程中绝不能吸烟。如果学生为吸烟者，他/她应与接待家庭讲明其吸烟习惯，并遵守接待家庭所规定的吸烟时间和地点。10. A student may not enter into any kind of contractual agreement be it business, religious or marital. Students may not take a job outside their home d

13、uring their stay in the Host Country. The only exceptions are occasional jobs in the neighborhood, such as lawn care or babysitting.学生不可以签署任何形式商业、宗教或婚约性质的契约。学生不可以在接待家庭以外的地方务工。学生只允许在邻居家帮忙，如作草坪护理员或家庭保姆。11. No violations of any State or Federal laws of the Host Country.学生绝不能违反接待国的地方法或联邦法。12. The Studen

14、ts personal property is not the responsibility of STS or the Host Family. Any lost or stolen personal property of the student, including money, which is not covered by any insurance policy is the responsibility of the student. 学生的个人财产不由接待家庭或STS机构负责。学生的任何个人财产（包括现金）的丢失或被盗只有学生个人负责，保险所承保范围并不涉及此项。13. STS

15、 discourages natural parents or guardians from visiting exchange students. STS机构不鼓励学生父母或学生监护人到接待家庭看望学生。14. All students must return to their home country after completing their program. Students are not allowed to remain in the Host Country after this time.在项目结束后，所有的学生必须返回本国；学生不被允许滞留在接待国。15. Finally

16、, all decisions made by STS Officials must be respected.最后，学生必须尊重STS机构所做的正式决定。I understand that I am responsible for keeping all STS Rules throughout the exchange program. Breaking any of these rules may result in my early return to my home country at my natural parents/legal guardians expense and w

17、ithout refund of program fees.我知道在整个交换项目中，我遵守STS规定的所有准则。违反其中的任何准则，我将可能被要求提前回国，而且机构将不会退费给我的父母。. .Signature of student Date学生签字 日期I/we understand that our son/daughter must keep all STS Rules throughout the exchange program. Breaking any of these rules may result in his/her early return at our expense

18、 and without refund of program fees.我/我们知道在整个交换项目中，我们的儿子/女儿必须遵守STS规定的所有准则。违反其中的任何准则，他/她可能被要求回国，而且机构将不会退费给我们。. .Signature of Father or Legal Guardian Date父亲或法律监护人签名 日期. .Signature of Mother or Legal Guardian Date母亲或法律监护人签名 日期Minor Authorization Form未成年人监护授权书Student Name 学生姓名Group Name (if applicable)

19、组织名称I agree to make sure my child understands that he or she must:我们在此确认我们知道孩子必须遵守如下规定（在参加此夏令营的过程中）：§ Behave reasonably and maturely during the program.在整个项目活动中有适当并成熟的行为表现§ Obey his or her school director, group leader, chaperone, host family parents, instructors and/or other program super

20、visors at all times.听从他或她学校的主任、领队老师、接待家庭和项目监督人的指导。§ Obey all United States laws including the minimum drinking age of 21 in the U.S.遵守美国的一切法律法规，包括21岁以下的未成年人不得饮酒的规定。I understand that failure to abide by the regulations above could result in immediate expulsion of my child from the program. By si

21、gning the form below, I agree to the following:我们明白，学生如果不遵守以上规定将会被从项目中立即开除。我们同意以下的管理条例并签字确认：§ The Group Leader or School Director can make emergency decisions for my child while he or she is on the STS program in the United States.在项目活动过程中， 我们同意授权给领队老师或学校的负责人在紧急情况下为我们的孩子做出合理的决定。§ I agree t

22、o release the group leader, host school, STS or any of their parent companies, subsidiaries, affiliates, agents, or employees, from any liability resulting from any causes of action for personal injury, disability, medical expenses, property damage of theft, or any other claims that may arise from my childs participation.我们同意授权给领队老师，接待学校负责人，STS机构以及其在当地的办公室以及负责人处理有关孩子在参加活动中所可能发生的人身伤害，残疾，医疗费，个人财产丢失等事宜。 § In the event of a medical emergency during students program, I