1.I/We, the parent(s) named above, do hereby declare that I/We are the parents of the above-named student and/or child (hereinafter the “Student”) and that I/We have legal custody of the Student.
2.I/We hereby grant and confer onto Summa Global Education and any of its affiliates or management company, at Summa’s sole discretion, (hereinafter the “Custodian”) custodianship for all purposes relating to the Student’s school application and selection process, school work, school activities, school grades, communications with schools, making arrangements for and communicating with the host family, medical decision-making and communications with medical care providers, medical insurance, medical insurance claims submission and processing and communication with medical insurance companies, during the Student’s stay in the USA while he/she is under the legal age in the US. Where used herein the term “medical” includes, but is not limited to, medical, surgical, dental and psychological.
3.In addition to the above and not in limitation thereof, I/We hereby grant my full permission and consent for Custodian to establish a place of residence for the Student, and for the Student to reside and travel with Custodian or with the selected host family.
4.In addition to the above and not in limitation thereof, I/We hereby grant Custodian my/our full authorization to make all decisions related to the Student’s educational and recreational activities and undertakings. I/We understand and agree that we will not contact the Student’s school directly.
5.In addition to the above and not in limitation thereof, I/We hereby grant the Custodian my/our full authorization to consent to any x-ray or other diagnostic tests, examination, anesthetic, medical, diagnosis, medical treatment, medical care, psychological care and/or hospital care, to be rendered to the Student under the general or special supervision and on the advice of any physician, surgeon, therapist or dentist licensed or certified to practice in any state in the United States of America, whether such diagnosis or treatment is rendered at the office of said physician, surgeon or dentist, at a hospital, or elsewhere. In addition to the above and not in limitation thereof, I/We hereby grant the Custodian my/our full authorization to have access to any and all records, including, but not limited to, insurance records regarding any such services.
6.In addition to the above and not in limitation thereof, I/We, further acknowledge and understand that if the Student becomes ill or incapacitated, Custodian may take any action they deem necessary for the Student’s safety and well-being, including securing medical treatment and psychological treatment as above and/or transporting the Student, at the Student’s expense. I/We release Custodian from any liability in regard to such actions.
7.In addition to the above and not in limitation thereof, I/We also acknowledge and understand that the Student is required to have specific immunizations prior to enrolling in classes, and if these immunizations need to be administered, it will also be at the Student’s expense.
8.The powers and authorizations granted herein to Custodian may be exercised by Custodian, as well as employees, staff and representatives of Summa.
9.I/We expressly direct that for all purposes, a photocopy of this Authorization and Consent shall be deemed to be an original and that any person shall be authorized to act upon such a copy as if it were an original.
10.I/We consent hereto and confer the powers and authority granted herein freely and knowingly in order to provide for the Student and not as a result of pressure, threats or payments by any person or agency.
11.By his/her signature below, the Student understands, acknowledges, and agrees to this Authorization and Consent and to the extent required, authorizes, agrees and consents to the terms of this Authorization and Consent.
12.We, the undersigned, agree and authorize that Summa to conduct and carry out all of the responsibilities through its affiliates and/or management company, Global Vision Management, Inc. at all times. Whenever “Summa” is used in this Agreement, the term shall also include and refer to Summa Global Education and its affiliates.