CSUB Field Trip Policy
|
|
- Sharleen Carr
- 5 years ago
- Views:
Transcription
1 CSUB Field Trip Policy Per the CSU Chancellor s Executive Order No. 715, the following constitutes the Field Trip Policy of California State University, Bakersfield (CSUB). For the purposes of this policy, field trip is defined as any off campus activity associated with a CSUB class. Students conducting research on their own time (e.g., independent study or thesis research) are not considered to be on field trips. Nursing students with laboratory sessions off site (e.g., clinical experiences) are also not considered to be field trip participants. For all CSUB field trips, the guidelines are: 1. A field trip should be made a course requirement and must appear in the course s syllabus with specific field trip dates. 2. The faculty member or instructor should visit the general area prior to the field study or be able to demonstrate sufficient knowledge of the area. Students should be provided with information about the area. 3. A detailed day-to-day instructional agenda must be prepared and distributed to all participants. a. This should include a general itinerary associated with the trip. b. One copy of the itinerary should be sent to the University Police Department and one to the department responsible for the course. 4. As needed, plan for and accommodate students with special needs. 5. Provide training for any equipment to be used on the trip. 6. Review permissible conduct rules and have each student sign the Field Trip Policy Awareness Form at least 24 hours prior to the field trip date. These include: a. The CSUB policy regarding alcohol and chemical substances (i.e. no alcoholic beverages or chemical substances except personal prescriptions medication, shall be transported in any state/university vehicle or personal private vehicle used in support of a university sponsored activity. See CSUB policy on alcohol at and the policy on illicit drugs at b. The CSU policy Use of University and Private Vehicles Policy Guidelines at c. The CSUB conduct policy at 7. All students must fill out the CSUB Waiver of Liability and Hold Harmless Agreement at least 24 hours prior to the field trip date. 8. Have students provide the names of people who should be contacted in the event of an emergency on the Field Trip Participant List. One copy of this list goes with you, one goes to the department and one copy goes to the University Policy Department. 9. Should there be an accident or injury, faculty should fill out STD 268 Report of Non- Vehicle Accident ( ) 10. Determine transportation needs. a. Recommend that students provide their own transportation to and from field trip sites whenever possible.
2 b. For university provided ground transportation (non-commercial), all drivers must be state employees or identified university volunteers and must be authorized to drive vehicles on university (state) business. c. For rented vehicles, contract through the University or State contracted vehicle rental agencies. All drivers must be state employees or identified University volunteers. If there is an accident involving a vehicle, please file STD 270 Report of Vehicle Accident ( ) 11. In case of an accident: Immediately phone 911 in all cases involving serious injury or death, multiple injuries, or extensive property damage. Your first priority is to care for any injured individuals. Know in advance who you are going to call for help while on a field trip. Be familiar with the location of local hospitals. Have at least one other participant carry emergency numbers and be certain they know what to do in an emergency. Record all pertinent information on the Accident Identification Card, STD. Form 269, before leaving the scene of the accident. If another vehicle is involved, detach the appropriate portion of the form and give it to the driver of the other vehicle. Immediately telephone (661) and give a verbal report of the accident. If no answer, leave a message giving your name, department, telephone number where you can be reached, and a brief description of the accident. Make no comment or statement regarding the accident to anyone except investigating police, CSUB or other state officials, or an identified representative of the State s insurance adjuster. If the situation attracts media attention, phone the Public Information Officer at Refer all media inquiries to the PIO. All drivers involved in an accident while driving on official CSUB business must complete the Report of Vehicle Accident, STD. Form 270, and submit it to the CSUB Department of Public Safety Services, within 48 hours. The appropriate administrator of every driver involved in an accident while driving on official CSUB business must investigate each accident promptly and thoroughly and prepare a Review of State Driver Accident, Form STD 274 and submit it to the CSUB Department of Public Safety Services, within five days. The CSUB Department of Public Safety Services will coordinate all reporting requirements. Note: In the event a driver is involved in an accident and the other party is non-cooperative do not get involved in a confrontation. Obtain as much information as possible, i.e., vehicle license plate number, make of car, description of driver, etc. and report this information to local police and to the CSUS Public Safety Office.
3 Forms Guide Form Purpose Copies Filed Field Trip Participant Roster Form Record of attendance for trip With the instructor on the trip and with the Dean s office 1 Policy Awareness Form Waiver of Liability and Hold Harmless Agreement Alcohol, drug, conduct and use of own vehicle awareness With the instructor on the trip and with the Dean s office 1 Releases CSUB from liability With the Dean s office 1 1 Collected by the department no less than 24 hours prior to the field trip date and filed in the school office. Documentation and Compliance 1. This policy will be disseminated by the Dean s Office to departments with courses requiring field trips at the beginning of each academic quarter. 2. The Dean s Office shall monitor adherence to this policy, and shall store all relevant documentation for a period of 3 years following each scheduled field trip.
4 RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: Activity Date(s) and Time(s): Activity Location(s): In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of The California State University, California State University, Bakersfield and their employees, officers, directors, volunteers and agents (collectively University ) from any and all claims, including claims of the University s negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity. I agree to hold the University harmless from any and all claims, including attorney s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, (c) and assuming all risks of participating in this Activity, including travel to, from and during the Activity.
5 I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. Participant Signature: Participant Name (print): Date: If Participant is under 18 years of age: I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this document, including (a) releasing the University from all liability on my and the Participant s behalf, (b) promising not to sue on my and the Participant s behalf, (c) and assuming all risks of the Participant s participation in this Activity, including travel to, from and during the Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document. I have read this two-page document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. Signature of Minor Participant s Parent/Guardian: Name of Minor Participant s Parent/Guardian (print) Date Minor Participant s Name
6 Field Trip Policy Awareness Form I,, in preparation for the field trip with Name (please print) on Instructor Name, have reviewed the CSUB policies pertaining to conduct, Date alcohol and drugs, found in the webpages: I further understand that when I provide my own transportation to and from the field trip sites, I assume all risk and take full responsibility for my actions. Signature Date Name Address City, State, Zip
Camper'Information'Sheet'
Camper'Information'Sheet' ' Camper sfullname:dateofbirth: T7shirtSize:Children sgender: (Circle)XSSMMLXL DoyouexpectyourchildwillhaveanyspecialconcernsaboutswimmingatSKC? (Circle)YesNo Ifyes,pleaseexplainbelow:
More informationNEW ORLEANS STUDY AWAY Summer 2016 June 19 th July 3 rd. Application Instructions
C OLLEGE OF H UMANITIES & S OCIAL S CIENCES NEW ORLEANS STUDY AWAY Summer 2016 June 19 th July 3 rd Application Instructions Friday, May 6, 2016 Complete and return to H-211 (H&SS Dean s Office) q Cover
More informationTITAN SOFTBALL CAMPS Registration Form
Registration Form CAMP DATE: CAMPER S NAME: CONTACT INFORMATION ADDRESS: CONTACT EMAIL: CONTACT PHONE: PLAYER INFORMATION AGE: GRAD YEAR (HS): PRIMARY POSITION (circle ONE choice): P C 1B 2B 3B SS OF UTL
More informationInternship Proposal Submission Form Master of Science Degree in Applied Marine and Watershed Science
Internship Proposal Submission Form Master of Science Degree in Applied Marine and Watershed Science This form must be signed by all parties before the start of the internship Student Name Student ID Date
More informationHow and When to Use Liability Releases and Waivers, Permission Slips and Informed Consent Agreements
How and When to Use Liability Releases and Waivers, Permission Slips and Informed Consent Agreements Nana Nakano, Office of General Counsel John Beisner, Cal State Fullerton What Bob the Builder Can Teach
More informationCALIFORNIA STATE UNIVERSITY, LONG BEACH RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
CALIFORNIA STATE UNIVERSITY, LONG BEACH RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Participant Name (Print): Field Trip, Voluntary or Extracurricular Activity:
More informationApplication for Audencia Winter Intersession November and December 2014 (field trip and workshop), January 2015 (abroad)
Application for Audencia Winter Intersession November and December 2014 (field trip and workshop), January 2015 (abroad) 1. Name Last Name, First Name Middle Initial 2. Student ID # 3. E-Mail Address (mandatory)
More informationMEDICAL INFORMATION FORM
SONOMA STATE UNIVERSITY SUMMER BRIDGE PROGRAM MEDICAL INFORMATION FORM In the event of an illness or injury the medical staff will need the following information to properly treat you. If you are a minor,
More informationBeyond the Hour WHAT IS HOUR OF CODE? GATEWAY SCIENCE MUSEUM & SPONSORS Present... for grades 5-8 TH
GATEWAY SCIENCE MUSEUM & 201 7 SPONSORS Present... Beyond the Hour F R I D A Y, AP R IL 14 T H, for grades 5-8 TH 20 17 3:3 0-5PM This workshop is independently paced and picks up at your skill level.
More informationCHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION
CHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION 530-898-6105 RCE@CSUCHICO.EDU RCE.CSUCHICO.EDU/PASSPORT/TANZANIA2016 PROGRAM APPLICATION IMPORTANT DATES: April 11,
More informationRELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: CSU, Chico Recreational Sports Youth Camps Activity Date(s) and Time(s): Summer 2018 (June 11 August 10,
More informationCSUF/NSM. Application Environmental Science Research in Thailand
CSUF/NSM Application Environmental Science Research in Thailand Application Checklist ESRT Application (sign the application) Permission for Emergency Treatment Release of Liability Personal Conduct Form
More informationCSUF/NSM. Application Environmental Science Research in Thailand
CSUF/NSM Application Environmental Science Research in Thailand Application Checklist ESRT Application (sign the application) Permission for Emergency Treatment Release of Liability Personal Conduct Form
More informationFor more information please refer to Board Policy #AP Sep-16
WHEN DO I NEED TO DO A FIELD TRIP REQUEST? CLUB/ORGANIZATION FIELD TRIP ACADEMIC FIELD TRIP Copies of clubs approved field trip request, Emergency Information Form, RCCD Student Excursion Contract, and
More informationFinance 101 Risk Management in Travel. California State University Channel Islands Katharine Hullinger, ARM Risk Management November 17, 2016
Finance 101 Risk Management in Travel California State University Channel Islands Katharine Hullinger, ARM Risk Management November 17, 2016 1 Executive Orders and Technical Letters Tech. Letter RM 2012-02
More informationFinance 101 Risk Management in Travel
Finance 101 Risk Management in Travel California State University Channel Islands Katharine Hullinger, ARM Risk Management November 17, 2015 1 Executive Orders and Technical Letters Tech. Letter RM 2012-02
More informationFORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.*
FORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.* Group Purpose of trip Destination/Place Date of departure Estimated time & location Date
More informationTRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL
TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL Program Name: Destination: Name(s) of LSC Employee Traveling with Group: LSC Employee(s) phone contact: - - or - - Budget
More informationGeneral Policy - Off-Campus Travel of Student Groups
General Policy - Off-Campus Travel of Student Groups Policy: All off-campus travel to an activity or event involving students shall be conducted in accordance with the State Board of Higher Education (SBHE)
More informationTryouts/Stunt Clinic
Tryouts/Stunt Clinic Wednesday & Thursday, April 19 & 20 Location: YUH 105 Time: 6-9 p.m. NOTE: Locations are subject to change. Should the location of any meetings changes, there will be prior notice
More informationInstructions for Completing Ford DSFL Waivers
Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly
More informationThe College of Wooster Checklist for Traveling
The College of Wooster Checklist for Traveling Send Student Organization Travel Itinerary to staff in Lowry Center and Student Activities one (1) week prior to departure. Send Organization Travel Roster
More informationLake Washington Rowing Club
Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate
More informationDate of Birth Address City State Zip
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. You have the right to consult
More informationRegistration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:
Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,
More informationStudy Abroad Application Checklist Form Student Travel Committee Student Activities Association
Study Abroad Application Checklist Form Student Activities Association The Study Abroad Application Checklist Form serves as an overview of forms that are required for submission. Study abroad students
More informationCAMP/CLINIC DATES: July 21 22, 2018 and/or August 11 12, 2018 MEDICAL HISTORY. Street City State Zip
Please fill out this form completely. It is important for the provision of proper medical care. The section marked Physician s Comments need only be completed if the participant has a major health problem.
More informationGENERAL RELEASE AND COVENANT NOT TO SUE THIS IS A GENERAL RELEASE AND WAIVER OF ALL LEGAL RIGHTS READ CAREFULLY AND UNDERSTAND FULLY BEFORE SIGNING
GENERAL RELEASE AND COVENANT NOT TO SUE THIS IS A GENERAL RELEASE AND WAIVER OF ALL LEGAL RIGHTS READ CAREFULLY AND UNDERSTAND FULLY BEFORE SIGNING Name of Participant: (print) Program and Destination:
More informationNSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.
PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release
More informationTravelearn Participant Form
Travelearn Participant Form Travelearn Program Faculty Coordinator Name Dates of Program This form must be completed in full, and must be accompanied by the following documents: $150 Administrative Fee
More informationPART A to be completed by the Program Director (then duplicated for completion of Part B by participating students)
CUNY INTERNATIONAL TRAVEL PARTICIPATION, WAIVER, AND EMERGENCY CONTACT FORM This form has been developed by the CUNY Office of the General Counsel (OGC) and cannot be altered or adapted except in the answerable
More informationTULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /
Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this
More informationInternational Education Application
International Education Application Name of International Mission Team: Circle one: Personal Information: Spring Break / Summer Name: (last) (first) (middle) ID# Date of Birth: Country of Citizenship:
More informationThe University of Oklahoma Norman Campus STUDENT TRAVEL POLICY University Sponsored or Organized Events
The University of Oklahoma Norman Campus STUDENT TRAVEL POLICY University Sponsored or Organized Events I. POLICY STATEMENT AND SCOPE The safe travel of students to and from events and activities that
More informationTHE 2019 CAROLINA CLASSIC AT TRYON INTERNATIONAL EQUESTRIAN CENTER CRI 3*, CRIJ3* & CRIYR3* ENTRY FORM
THE 2019 CAROLINA CLASSIC AT CRI 3*, CRIJ3* & CRIYR3* ENTRY FORM May 9-12 Tryon, NC DUE MAY 8, 2019 For Office Use: # Horse Name: FEI #: Sire: Dam: Breed: Year Foaled: Sex (circle one): Stallion Mare Gelding
More informationAuburn University Montgomery
Auburn University Montgomery Coach Newell s AUM Softball Prospect Camp Coach Newell will be hosting softball prospect camps on multiple dates throughout the fall of 2017. These camps will be limited to
More informationOVERSEAS PROGRAMS STUDENT AGREEMENT
OVERSEAS PROGRAMS STUDENT AGREEMENT I, (print or type name of Student), acknowledge that I have voluntarily applied to an overseas study program ( Program ) offered by the Santa Monica Community College
More informationUniversity of Maryland-Campus Recreation Services MAP Trip Registration Packet
University of Maryland-Campus Recreation Services MAP Trip Registration Packet Trip Name: Trip Please read the following trip information carefully. Please initial and sign where requested to acknowledge
More informationBITCAMP TERMS AND CODE OF CONDUCT BY PARTICIPATING IN BITCAMP, YOU AGREE TO THE FOLLOWING TERMS AND ALL OTHER APPLICABLE DOCUMENTS.
BITCAMP TERMS AND CODE OF CONDUCT BY PARTICIPATING IN BITCAMP, YOU AGREE TO THE FOLLOWING TERMS AND ALL OTHER APPLICABLE DOCUMENTS. Henceforth, "I", me, "my", myself, and other first-person pronouns shall
More informationTEXAS A&M INTERNATIONAL UNIVERSITY
AGREEMENT FOR WAIVER, INDEMNIFICATION, ASSUMPTION OF RISK AND MEDICAL TREATMENT AUTHORIZATION I,, age, desire to participate voluntarily in all activities of the ( Activity ), which is sponsored or conducted
More informationAthletics Participation and Pre-Participation Head Injury/Concussion Reporting Form
Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of
More informationCOLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel)
COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel) 1. I, the undersigned student desire to participate in the following activity/trip ( Activity ),
More informationField Trips Guidelines and Procedures. A Tutorial Presented by University Risk Management Cal Poly Pomona
Field Trips Guidelines and Procedures A Tutorial Presented by University Risk Management Cal Poly Pomona 2 About this Presentation Out of classroom learning experiences bring with them certain risks. It
More information(Student Last name, First name Middle Initial).
2013-14 (Student Last name, First name Middle Initial). Consent for Field Trip (P1a) DHS Band Combined Form P1a, P1b, P1c I hereby consent for the above named student to participate in athletic team, band,
More information2018 Oakland Soccer Camp Application BOYS CAMP ONLY
2018 Oakland Soccer Camp Application BOYS CAMP ONLY Name: Address: City: State: Zip: Home Phone: Work Phone: Email (Required): Age: Grade: (At time of camp) (Fall 2018) All confirmations will be sent via
More informationWaiver, Release of Liability, Indemnification and Consent to Medical Attention
Waiver, Release of Liability, Indemnification and Consent to Medical Attention 1. Voluntary Participation. I understand and confirm that my participation in the Program is voluntary. 2. Identification
More information2016 5K Reindeer Run/Walk Team Registration
2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per
More informationTraveler and Emergency Contact Information
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four (4) weeks prior to making
More informationMEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM
MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM Camp Information Address: City, State, Zip Code: Gender: Medical Information The decision whether to permit the participant identified
More informationAGREEMENT TO TERMS AND CONDITIONS OF CPCC EDUCATION ABROAD AND WORK-RELATED TRAVEL PROGRAMS
Please initial each page. 1 AGREEMENT TO TERMS AND CONDITIONS OF CPCC EDUCATION ABROAD AND WORK-RELATED TRAVEL PROGRAMS I, (print your name), in consideration of Central Piedmont Community College ( CPCC
More informationREQUEST FOR AUTHORIZATION STUDENT TRAVEL: UNIVERSITY ORGANIZED OR SPONSORED EVENTS THE UNIVERSITY OF TEXAS AT AUSTIN. Requestor/Sponsor Information
Part I. Requestor/Sponsor Information Name of University Employee Responsible for Trip: Position /Title: Administrative Unit/Organization: Phones: Office Cell Email Part II. Trip Information Purpose of
More informationAFCC CAMPER REGISTRATION FORM
AFCC CAMPER REGISTRATION FORM Camper s Name Gender: M F Phone Number Email Address Address City/State/Zip Sponsor or Student Grade Completed (if student): Age Birthdate Church City T-Shirt Size: YM YL
More informationVolunteer Application
Volunteer Application Date Thank you for your interest in the HSSEMO volunteer program. Age Requirements: Volunteers must be 16 years of age or older or they must be accompanied by a trained parent or
More informationCUNY OFF-CAMPUS STUDENT TRAVEL APPROVAL FORM New York City College of Technology
CUNY OFF-CAMPUS STUDENT TRAVEL APPROVAL FORM New York City College of Technology The Off-Campus Student Travel Approval Form must be completed by the Trip Sponsor and submitted to the Office of the Provost/VP,
More informationStudent Travel Packet The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four weeks prior to making
More informationStudy Abroad Costa Rica 2016
How to turn in this application: Scan and email to ckoch@coloradomtn.edu. Study Abroad Costa Rica 2016 Fax to 970 569-3309 Attn: Carol Koch. Mail Colorado Mountain College Attn: Carol Koch 150 Miller Ranch
More informationCardiothoracic Surgical Skills and Education Center 2015 Stanford Summer Internship
2015 Stanford Summer Internship PROGRAM DATES: Program 1: June 22, 2015 to July 17, 2015 Program 2: July 20, 2015 to August 14, 2015 APPLICATION DEADLINE: February 13, 2015 Please (1) fill out the form
More informationStudent Domestic Travel Instructions
Student Domestic Travel Instructions This information is provided to assist University Faculty and Staff members in planning and conducting classroom and/or co-curricular trips. Page 1. This page provides
More informationSchedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete
When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45
More informationRELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Name : Date of Birth: Camp: Camp Date(s) and Time(s) In consideration for the privilege to attend the Oakland University
More informationMOTIVATE ME Young Men s Conference 2014
Greetings! Thank you for your interest in the Illinois Association for College Admission Counseling s MOTIVATE ME Young Men s Conference! Whether you applied online or sent us a paper application, these
More informationCHAMPAIGN COMMUNITY UNIT SCHOOL DISTRICT NO. 4 Champaign, Illinois FIELD TRIP PERMIT
FIELD TRIP PERMIT (School) (Student s Name) (Teacher/Sponsor) (Telephone Number) PARENTS/GUARDIANS: A field trip to is planned for (class or group) on. The trip will begin at a.m./p.m. and return at a.m./p.m.
More informationTraveler and Emergency Contact Information
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least twelve (12) weeks prior to
More informationTraveler Printed Name Traveler Signature Date
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four weeks prior to making
More informationNSM-ICC Funding Request Packet: TRAVEL
Participant Name: Sponsoring Club: NSM-ICC Funding Request Packet: TRAVEL The NSM-ICC prefers that all funding request proposal packets be submitted prior to event for allocation consideration. We understand
More informationFlorida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)
Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) (Commercial Activity Providers) WAIVER AND RELEASE OF LIABILITY
More informationCITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR
CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start
More informationINSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
More informationStudent Travel Packet The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four weeks prior to making
More informationCOLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program:
COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program: THIS FORM MUST BE SIGNED AND RECEIVED BY THE CENTER FOR INTERNATIONAL EDUCATION
More informationRelease of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.
Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy
More informationSTATE UNIVERSITY OF NEW YORK Overseas Academic Programs AGREEMENT AND RELEASE FOR STUDY ABROAD
STATE UNIVERSITY OF NEW YORK Overseas Academic Programs AGREEMENT AND RELEASE FOR STUDY ABROAD For Participants in State University of New York Administered Overseas Academic Activities To the Student:
More informationWAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:
WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially
More informationCatholic Mutual CARES
Catholic Mutual CARES Field Trip Risk Management Information The purpose of the enclosed information is to provide sample forms and procedures to minimize the exposures created by participation in field
More informationRegistration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:
Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player
More informationASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT Participant s Name: Age: Date of Birth : (M) (D) (Y) Address: City: Province:
More informationCAPITAL BADMINTON ACADEMY.
CAPITAL BADMINTON ACADEMY www.capitalbadmintonacademy.com ABOUT US Welcome to Capital Badminton Academy! We re a badminton academy based in DMV (DC, Maryland and Virginia) and we train domestic and regional
More informationSTUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT
STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT I,, desire to participate voluntarily in the Study Abroad Program, West Texas A&M University, described
More informationPersonal Medical Record
Personal Medical Record Personal details Age: Height (in meters): Weight (in kgs): BMI (kgs/metres 2 ): *Online BMI calculation tools are easily available 1. Any previous illness - past 3 months (mention
More informationPlease note that there is no liability coverage for wrestling activities held at a home or residential dwelling
Insurance coverage 2017-18 Insurance Information At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and
More informationFACULTY STUDY ABROAD PACKET
FACULTY STUDY ABROAD PACKET This is the official application for the faculty sponsor in charge of a study abroad program at Northeastern State University. Please complete this application in full, including
More informationSt. Thomas of Villanova Scholars (STOVS) Summer Program July 5-22, 2017
St. Thomas of Villanova Scholars (STOVS) Summer Program July 5-22, 2017 Personal Information Full Name: Address: Last First M.I. Street Address Apartment/Unit # City State ZIP Code Home Phone: ( ) Alternate
More information2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education
2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students
More informationPARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE
More informationInstructions: 2. a copy of passport. 3. a completed "Project Abroad" form. 4. a completed "Assumption of Risk and Release" form
Instructions: The following documentation needs to be submitted to the International Programs Office (Liberal Arts Building, Room 016) for approval of international travel supported by the University:
More informationNON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Albright allows Participants to participate in Participant activities that may involve or require overnight
More informationDRAFT TEMPLATE STUDENT-INTERN CONTRACT FOR INTERNATIONAL INTERNSHIP PLACEMENTS
DRAFT TEMPLATE STUDENT-INTERN CONTRACT FOR INTERNATIONAL INTERNSHIP PLACEMENTS ELIGIBILITY: In order to be eligible to participate in a Carleton University individual student program internationally, you
More informationForeign Travel Participation Agreement and Waiver of Liability
Foreign Travel Participation Agreement and Waiver of Liability In consideration of the undersigned participant s (the Participant ) participation in the [Name of School] (the School ) trip to [Trip Location]
More informationFor Participants in State University of New York Administered Overseas Academic Activities
AGREEMENT AND RELEASE FOR STUDY ABROAD STATE UNIVERSITY OF NEW YORK Overseas Academic Programs For Participants in State University of New York Administered Overseas Academic Activities To the Student:
More informationASSUMPTION COLLEGE SUMMER Rome Program APPLICATION
ASSUMPTION COLLEGE SUMMER Rome Program APPLICATION APPLICATION CHECKLIST Applications will be considered complete when the following documents have been submitted: This application completed and signed
More informationPolicy on Motor Vehicle Use
Business & Financial Affairs Approved By: Effective Date: 5/1/13 Page 1 of 4 PURPOSE: To establish parameters for use of motor vehicles on University business that support the vehicular needs of campus
More informationSTUDY ABROAD APPLICATION AND DEPOSIT
Please print, sign, staple and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. Upon receipt of your deposit and study abroad application, FVCC will contact you
More information2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS
2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More information2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS
2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More informationCamp Medical Information & Release Form
Global Youth Ministry Global Youth Camps 40 Blackhawk Trail Chatsworth, GA 30705 877-251-1800 www.globalyouthministry.org Camp Medical Information & Release Form Name Gender Age Birthdate / / Church/Org
More informationCSU Group International Travel Paperwork Checklist
CSU Group International Travel Paperwork Checklist Please read all the attached materials and provide accurate and complete information as requested. If a signature is requested on a document, you must
More informationInternational Educational Experience Agreement
University of Pittsburgh Office of Undergraduate Research, Scholarship, and Creative Activity Dietrich School of Arts & Sciences This Agreement is the legally binding document that will guide you and inform
More informationMCLA Trip. PARTICIPANT INFORMATION for Travel Program NAME OF TRAVELER. (city) (state) (zip)
PARTICIPANT INFORMATION for Travel Program NAME OF TRAVELER AGE BIRTH DATE PARTICIPANT S PERMANENT ADDRESS: apt. # (city) (state) (zip) PERMANENT HOME TELEPHONE NUMBER: ( ) EMAIL ADDRESS PARENT/SPOUSE
More informationTrip Coordinator Training
Trip Coordinator Training BGSU Travel Initiative When a registered student organization desires to participate in, or sponsors an event that occurs off the campus, and participation requires vehicle use,
More informationUNITED STATES AUTO CLUB
UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
More information