Explanatory Notes about the Student Agreement Form for National and International Travel:

Transcription

1 Explanatory Notes about the Student Agreement Form for National and International Travel: The form provides a set of basic, minimal requirements for students accepted for CSM-sponsored travel that involves an overnight stay. Trip facilitators are free to add their own additional expectations. This form was designed based upon the ideas of faculty who have led such trips, faculty more generally, and by consulting other colleges and universities forms, policies, and procedures. Regarding the language about consumption of alcohol: This form allows the trip facilitator to determine prior to the trip that there are circumstances congruent with the trip s educational purposes for students 21 or older to consume alcohol (such as at a winery in a country where wine is a major part of the culture and economy, or at a networking dinner at an academic conference). Trip facilitators are also free to state in the form that there are no circumstances congruent with the educational purposes of the trip where alcohol may be consumed. Regarding the language about health insurance, CSM student athletes are required to have health insurance. Other students are not required to have health insurance. It is possible to purchase affordable health insurance for short periods of international and national travel. This will be required of uninsured students who desire to participate in international travel and for those students whose domestic health insurance policy does not cover international travel. For national travel, students would indicate that they possess health insurance, or (if they do not possess insurance) that they are responsible for their health care costs (if any) incurred during the trip. Short-term international and national medical insurance coverage can be obtained through the following websites: (for coverage outside of the United States) (for coverage within the United States)

2 College of Saint Mary Student Agreement Form for National and International Travel This Agreement is signed and given by the undersigned to the appropriate Vice President at College of Saint Mary in consideration for the opportunity to participate in CSM-sponsored travel that involves at least one overnight stay. Participation in this trip is considered to be both an honor and a responsibility. I understand that I am representing College of Saint Mary and my behavior during this experience is a direct reflection upon the College. I will attend and actively contribute to all parts of this experience, including participating in all pre-trip and post-trip meetings. I will act responsibly and professionally during scheduled and free time. I understand that the College of Saint Mary Student Handbook and Code of Conduct are in full effect during the entire trip. I will obey all state and U.S laws, laws of the countries I am visiting, as well as College policies and regulations. If I am under the age of 21, I agree that I will not consume alcohol. If 21 or older, I will not provide alcohol to minors. If I am 21 or older and choose to consume alcohol, I will do so only under circumstances congruent with the educational purposes of the trip as determined by the Facilitator(s) prior to the trip. I will be subject to College discipline if my behavior generates disorder, creates disturbance, damages property, or presents a danger to myself or others. I understand that the Facilitator(s) have the authority to send me home at my own expense for violating this agreement, state laws, or the laws of the United States. I respect the authority and responsibility of the Facilitator(s) and will abide by their decisions. National and International Travel sponsored by College of Saint Mary ends on the last scheduled day of the trip upon return to the final destination stated in the itinerary. I will return with my group unless prior arrangements have been made and approved by the College. College of Saint Mary is not responsible for any student electing to remain at a site, or travel to another destination after the trip. Safety is a primary concern. I will promote a safe environment and understand that some aspects of the trip may be changed or canceled to address safety. In order to promote communication among group members, I agree to limit cell phone, computer, and other electronics use to emergencies and to free time. I will turn my cell phone off during presentations and other scheduled time. Health Insurance Section: (please complete either option 1 or 2) 1) I possess health insurance. My policy is through (name of insurance company) and my policy number is. I understand that I am responsible for meeting the deductible on my insurance. OR

3 2) I do not possess health insurance, and I understand I am responsible for any health care costs I incur during this trip. For all students traveling on international trips only: If international travel insurance for health care is not included in my health insurance policy, or if I do not possess health insurance, I will purchase special international health insurance coverage for the period I plan to travel outside the United States. I understand that my $ deposit for the trip is nonrefundable, even if I am unable to go on the trip as planned. I understand that I owe $ towards the cost of the trip, which I will pay in full by. The Facilitator(s) of this trip may add additional expectations here: By signing below I register my agreement with the statements listed on this document. Printed Name (Student) Signature (Student) Printed Name of Parent/Guardian (if the student is a dependent) Signature of Parent/Guardian (if the student is a dependent)

4 College of Saint Mary Release of All Claims For and in consideration of being allowed to participate in the (specify activity) by the College of Saint Mary, I release College of Saint Mary, its faculty and staff, and its administration from all claims, demands, damages, actions, and causes of action on account of damage to property, bodily injuries, or death resulting or to result from (specify activity) occurring on (date, time location) by reason of (describe risks involved). The undersigned student further authorizes CSM and its agents to provide emergency medical care should it be necessary. It is understood and agreed by the parties to this release that this instrument is a full and final release of all claims of every nature and kind whatsoever, and that this instrument releases claims that are known and unknown, suspected and unsuspected as a result of the activity described above. I further state that I have carefully read the foregoing release and know its contents and sign the same as my own free act. Signature of Student Signature of Parent/Guardian (if student is under age 19) Signature of College Official

5 College of Saint Mary Emergency Contact Information Form EMERGENCY CONTACT INFORMATION FOR: Address: City: State: Zip Code: In the event of an emergency during the Travel Seminar, please attempt to contact these persons in the order listed: City: State: Zip Code: City: State: Zip Code: City: State: Zip Code: