To be completed by the Group Organizer and submitted by Fax: 613 727-3831 or e-mail

with the Travel Purchase Memo to EXPERIENCES CANADA within 48hrs of receiving

.
11. STATEMENT OF GROUP ORGANIZER

GROUP NAME: ________________________________________________________ PROJECT NUMBER:_____________

GROUP ORGANIZER: _________________________________________________________________________________________

The Group Organizer bears the responsibility of providing all participants a safe, fun and
educational experience. However, the success of the program is also incumbent on all parties
understanding their roles and responsibilities. Your signature on this form certifies that you have
fulfilled your responsibilities of reviewing and discussing all aspects of the program with
participants, their families and your twin group Organizer.

NO TRAVEL ARRANGEMENTS WILL BE FINALIZED UNTIL THIS FORM HAS BEEN COMPLETED,
SIGNED AND RETURNED TO EXPERIENCES CANADA.

PARENTAL CONSENT
□ I have informed all parents of their responsibilities in this exchange program.
□ All parents have signed the Parental Consent Form.
□ I will retain on file, in a secure place, under lock and key, the necessary signed consent
forms and medical information for all youth participants.
□ I will share all hosting activities/itineraries with all parents to keep them informed.

PARTICIPANTS – YOUTH and ORGANIZERS/CHAPERONES

□ All participants have signed the Participant Agreement and have agreed to observe an
appropriate Code of Conduct (either the group’s own code or EXPERIENCES CANADA’s )
□ The consequences of non-compliance have been explained and agreed to by all.
□ I have forwarded to EXPERIENCES CANADA a signed Waiver and Consent for each
participant in this program (youth and adult).
□ The individual participants have been twinned and are communicating with each other.
□ Each Organizer and Chaperone has agreed to abide by the school/group’s rules &
regulations at all times.
□ Each Organizer and Chaperone has agreed to respect the ratio of Youth vs. Adults at all
times during the travel and hosting weeks.
□ I have discussed the learning objectives and school/group rules & regulations with my
twin organizer and understand the roles and responsibilities.

HOST FAMILY SCREENING if applicable

□ I have explained the responsibilities involved in a reciprocal home stay exchange to all
participants and their families.
□ I have discussed mandatory home screening, insurance requirements, liability issues and
emergency procedures with all participants and their parents.
□ All homes that will be hosting a visiting youth participant have been screened and
approved.

11. Statement of Group Organizer June 2019 Page 1 of 2

 To be completed by the Group Organizer and submitted by Fax: 613 727-3831 or e-mail
with the Travel Purchase Memo to EXPERIENCES CANADA within 48hrs of receiving

□ I have verified that all participating adults (organizer and chaperone) and every adult 18
years and older living in the household provided a clear police record and vulnerable
sector checks.

COMMON STAY ARRANGEMENTS if applicable

□ I confirm that our common stay facility is safe, has the appropriate amenities (separate
male/female washrooms, kitchen facility, beds, linens etc.) and have provided all the
contact information to EXPERIENCES CANADA in a request for Common stay letter.
□ I have provided Experiences Canada a confirmation of the building insurance where the
group will be staying.

HOSTING
□ All participants and chaperones will accompany our twins throughout their stay.
□ I have organized this exchange following the policies and procedures of my School or
Association and in accordance with the safety and security policies as outlined in
EXPERIENCES CANADA’s Organizer’s Manual.
□ I have verified that all suppliers have adequate insurance for the services/activities that
they provide.

DOCUMENTATION
□ I have sent in all required documentation to my EXPERIENCES CANADA representative.
□ At the of my exchange, I will return the completed financial and non-monetary reports.
□ At the end of my exchange I will complete the Post-Exchange Questionnaire. The URL link will
be sent to me after my exchange ends - separate survey URL links will be sent to parents and
participants directly.

___________________________________________________ _____________________________
Group Organizer’s Signature Date

11. Statement of Group Organizer June 2019 Page 2 of 2