Student Name Form10A10B10C10N10M10P10S10TL6AKL6DBL6EFL6HJL6LKL6MKL6SWL6TPAddress your child will be residing at overseasWith whom will your child be residing Relationship to your child Language spoken When not at the work placement, what measures have been implemented to supervise your child How will your child get to and from the placement Emergency contact details World Nomads or equivalent insurance policy detailsPARENTAL/CARER DECLARATION* I agree to fund all work experience related costs, e.g. Travel/Insurance/Accommodation. * I have read the recommendations regarding overseas travel & work experience insurance with World Nomads and have taken out a policy with them / have a different insurance policy (please circle as appropriate). I take full responsibility to ensure cover is in place for emergency medical expenses, personal accident and personal liability * I have read the recommendations regarding overseas travel & work experience insurance with World Nomads and have taken out a policy with them / have a different insurance policy (please circle as appropriate). I take full responsibility to ensure cover is in place for emergency medical expenses, personal accident and personal liability * I have read the ‘Young people and work experience’ document and am satisfied with the health and safety arrangements made for my child at the Overseas Work Placement, and whilst in the care of the person mentioned above. I enclose a copy of my child’s travel plans.Max. file size: 50 MB.
