(Submit via FAX ONLY with GSL Individual Application)

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Please read all of this form carefully before filling it out completely and then
send it via FAX ONLY to the GSL office in Granada at +505-552-8538 (Nicaragua).

Parent must complete and sign this form and also the registration form of the unaccompanied minor student.

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This agreement pertains to the GSL student:

Name: ____________________________________________________,

Age: ____________, Birthdate: _________________________________,

who will be registered for Spanish language or eco-tourism programs with Granada Spaniah Lingua (GSL). This agreement is in effect during the dates he/she receives or is registered for services, lodging or instruction provided by GSL in Nicaragua.

I, the undersigned parent:

Name: _______________________________________________,

Address:__________________________________________________________,

Phone(s): _________________________________________________________,

E-mail: ___________________________________________,

as parent of the above named student who will be less than 18 years old upon the initial date of his/her program with GSL agree to not hold GSL, agents or employees liable for any injury or loss that my child may experience during the course of his/her travel or Spanish school program, activities or homestay with GSL. I believe that my child is in good enough physical/mental/emotional health to adapt to the challenge of traveling and living in a foreign environment and culture and have provided for travel and emergency medical insurance for my child during his/her program with GSL.

In case of all emergencies or serious problems my child may experience in the course of his/her program with GSL, I will take responsibility for my child’s actions, needs, and financial obligations, and if deemed necessary by GSL, I will take immediate physical custody of my child either directly or through a family representative in Nicaragua:

Name: _________________________________________________________,

Address: ____________________________________________________________,

Phone(s):______________________________________________________,

and will make immediate direct payment to GSL or any other creditor in or out of Nicaragua for any and all financial obligations incurred by my child during the time of his or her program with GSL.

I agree to the terms of this agreement as described above.

Parent Signature: ______________________________________ Date: _________________

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