EARLY RELEASE TO NATURAL PARENTS/GUARDIANS
Under the following conditions a student may be released from their exchange responsibilities prior to their leaving this country and the expiration date of their DS-2019:
1. The student may be released to the natural parents/guardians only. The natural parents must come to Oregon to pick up the student. The student may not fly to meet them at an alternate location, nor may they be picked up by a relative, friend, or fly to the home of a relative or friend to be released.
2. The student may not be released until completion of the final Rotary District 5100 sponsored Youth Exchange Event for the year. The date of the final event may change from year to year with the final event date for the current Rotary year.
3. If the student has been excused from the Final Rotary District Event for the year in order to attend his/her graduation, then the release becomes effective at the end of graduation activities.
4. Early releases must be requested and approved thirty (30) days in advance of the date of release.
5. Parents must show proof of medical insurance meeting current Rotary requirements. Insurance provided by Rotary District #5100 is canceled on the date of student release.
6. Natural Parents/Guardians, Hosting Rotary Club, Rotary 5100 District YEO, and Rotary District 5100 Chair must approve early release with their signatures on this form.
7. Parents must supply a letter from Sponsoring District YEO approving early release.
8. Student may travel for no more than 30 days in this country on his/her J-1 Visa in the custody of their parents. Students may not stay in the country beyond the expiration date of his/her DS-2019.
9. District 5100’s responsibility for the student ends on the actual date of student release.
By our signatures below, we certify that we have read, understand, and complied with the conditions for releasing _________________________ to his/her natural parents on ______________. Date
Parents/Guardians__________________________________________________________________ Date ___________
Printed Name _____________________________________________________________________
Hosting Club ______________________________________________________________________ Date ___________
Printed Name _____________________________________________________________________ Title _______________________
Country Officer ____________________________________________________________________ Date ___________
Printed Name _____________________________________________________________________
District Chair ______________________________________________________________________ Date ___________
Printed Name ____________________________________________________________________
