chaperone

Chaperone

* This information is mandatory

Select your photo here (.jpg, .gif, .png)

YOUR INFORMATION

Name of your organization

First Name

Middle Name

Last Name

Nickname (How would you like to be called)

Gender

Male Female

Date of birth (DD/MM/YY)

E-mail

Cell Phone Number (if applicable)

PERSONAL INFORMATION

Address

City

State

ZIP (Postal Code)

Country

Home Telephone:

Work Telephone

Occupation

Emergency contact person

Have you ever been convicted of a felony?

Yes No

Language proficiency (for languages other than your native language):

Proficiency (Language, Years studied, Speaking):

How long have you been a volunteer and/or staff member?

Comments

Have you ever served as a flight or bus chaperone with your organization or any other organization?

Yes No

If yes, please describe

Are you an former exchange student or have you had experience living abroad ?

Yes No

HEALTH INFORMATION

Do you have any physical restrictions, impairments, or allergies that will limit your walking, sightseeing, or hinder your participation as a chaperone?

Yes No

If yes, please explain

Do you have any physical restrictions, impairments, or limitation to sitting on a bus for 8-10 hours, with minimal breaks?

Yes No

If yes, please explain. How Many hours would you feel comfortable on a bus?

Do you have any dietary restrictions, including any which are for religious reasons or are self-imposed?

Yes No

If yes, please explain

Please give detailed information concerning any medical impairment or disability that could affect your ability as a tour chaperone.

Are you currently taking any medication or injections?

Yes No

Yes If yes, please explain

GENERAL INFORMATION

Can you swim?

Yes No

PARTICIPATION AGREEMENT

Which trip(s) are you interested in being a Chaperone? (Please specify trip(s) and dates)

Trip Name

Start Date

End Date:

Can you arrive a day prior of start date of the trip if needed?

Yes No

Departure Airport Options:

1st Option

2st Option

I certify that the foregoing information is correct. Misrepresentation of information could result in disqualification.

Yes

“The trip was amazing to be with my friends and also to have them all on this trip together. I will never forget all of the moments that we had. Also I want to say that Belo had a very good work with us.”

Mariano, ChileRotary Germany

“The support was incredible!! The staff took care of us in all the moments and respected ours individualities. They talk with us, give tips. I would say that they are more than staffs, they are our friends. Thanks for everything!”

Elaine Silveira, BrazilAFS Germany

“Thank you all so much for this incredible opportunity to travel Europe and meet all the amazing people who are now my friends for life. You´ve changed my life for the better and I will now forever associate certain people, objects and places with these memories that I´ve made during this trip!. I can´t thank you enough.”

Jovi Revil, PhilippinesAFS Austria

Chaperone

Chaperone

YOUR INFORMATION

PERSONAL INFORMATION

HEALTH INFORMATION

GENERAL INFORMATION

PARTICIPATION AGREEMENT

Company

Trips

Camps

Contact

+34 629 01 88 81

+34 629 018 881

Belo Europe Travel

+34 629 01 88 81

+34 629 018 881

Belo Europe Travel

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