[City of Gastonia] Chaperone Application

Gastonia Sister Cities Exchange Program Adult Chaperone Application

Adult Chaperone

Thank you for your interest in supporting our student ambassadors. Chaperones play a vital role in ensuring a safe, enriching experience for students. Please complete the following application in full. All chaperones must be at least 25 years old by the time of the trip. Parents cannot chaperone trips for their own students.

Personal Information

Preferred Name

Best Email

Best Phone Number

Availability and Commitment

Which exchange are you interested in chaperoning?

Germany Trip (June 2026)

Peru Trip (May-June 2026)

Either/ No preference

Are you available for pre-trip planning meetings and trainings?

Yes

Are you available to participate in parades, fundraising, and student meetings leading up to the trip?

Yes

Can you commit to being present for the full duration of the trip?

Yes

Experience and Qualifications

Occupation:

Languages spoken (other than English):

Do you have prior experience working with youth?

If yes, please describe:

Have you previously chaperoned student travel?

If yes, please describe:

Travel and Health

Do you have a valid US Passport or be willing to obtain one by January 2026?

Yes

Do you have any health concerns or limitations we should be aware of?

Yes

If yes, please describe:

Background Check:

Have you ever been convicted of a felony or offense involving minors?

Yes

Are you willing to submit to a background check?

Yes

References: Please provide 2 non-family members who can speak to your character and working with youth.

Reference #1 Phone Number

Relationship:

Reference #2 Phone Number

Relationship:

Motivation

Why do you want to be a chaperone for this exchange program? (150-250 words)

Consent & Signature

By signing below, I confirm the information provided is accurate and complete. I understand the responsibilities and expectations of a chaperone and agree to uphold them if selected.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.