Student Name (As it appears on your passport):
Student Email Address:
Student Cell #
Where are you going?
Purpose of trip (be specific):
Is this an overnight trip?
Departure Date from Victoria
Time of Departure
Return Date to Victoria
Time of Return
What are your travel plans? Be specific, explain how will travel from your homestay to final destination - bus, car, ferry and/or airplane? Dates/Times?
Name any other international students you will be travelling with:
Address of where you will stay:
Supervising Adult name (must be 25 years or older):
Supervising Adult phone/cell:
Supervising adult email address:
Your relationship to supervising adult:
I have asked my natural parents to email email@example.com confirming they know my plans and who the supervising adult is.
I have discussed this with my host family and they know my plans. (We will be confirming with your homestay that they know your plans).