Consent of Parent/Guardian of Student Undergoing the

Cultural Exchange Program/USA Work and Travel Program

Date_______________

I, ______________________________________________, the Parent/Guardian, am giving my

consent to _________________________________________________ to undergo the Cultural
Exchange Program or the Work and Travel Program in the United States under Zip Travel
Philippines during his/her summer break from _________ to __________, 20__

I fully understand that Zip Travel Philippines (Inner Outer Travel Inc.) will exercise utmost
diligence to ensure his/her safety and well being, however it shall not be accountable for any
incident that may occur beyond the control of the company, or caused by his/her negligence.
Furthermore I understand that I, being the guardian will be held liable in the event that he/she
failed to comply with the policies of the program.

Signature over Printed Name

Date

Relationship to the Student:

Contact Number:
E-mail Address :
Home Address:

*Please attach a copy of the Barangay clearance of the parent/guardian