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2. Parent/Legal Guardian

   The student's application must be submitted with a deposit of $250.  

   Should your child not be selected for participation in the Sister City Program, this deposit will be returned to you. 

   If your child is selected this deposit will be held by SCIRC and applied towards your balance due for the trip. 

   The airline tickets and hotel accommodations must be paid for in advance. SCIRC will inform you of those costs and payment deadline(s) once they are known. If payment is not received prior to the deadline(s), your child may no longer participate in the program. If, after acceptance, your child should leave the program for any reason, money collected on your child's behalf but not yet expended, will be returned to you. 

   
   

4. Electronic Signature Agreement*

   I (we) agree to allow our son or daughter to participate in the Sister City Program to Shizuoka City/Kambara, Japan in the summer of 2026 if he/she is accepted. I (we) have read the above information and understand and agree to it. I (we) further understand and agree that I (we) are responsible for all costs associated with my child's participation in the Program, and shall make payments in accordance with the deadline(s) established by SCIRC.

   By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

   1. I agree.
6. Electronic Signature*

   Signature(s) of Parent/Legal Guardian #1

7. Signature Date*
   Signature Date
9. Electronic Signature

   Signature(s) of Parent/Legal Guardian #2

   
   

10. Signature Date
    Signature Date
14. Application Checklist

    Applications will not be considered "complete" until

    1.  Completed student application submitted

    2. "Student Agreement Form" is submitted

    3. "Parent/Guardian Permission Form" is submitted

    4. $250 deposit mailed to  SCIRC RE: "Student First and Last Name" City Hall 44 W Washington Street, Shelbyville, IN 46176

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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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