Santa Monica College Administrative Regulation - Students Activities and Student Conduct

Size: px
Start display at page:

Download "Santa Monica College Administrative Regulation - Students Activities and Student Conduct"

Transcription

1 Santa Monica College Administrative Regulation - Students Activities and Student Conduct (AR ) Extracurricular Trips Arrangements for trips by clubs and other non-athletic extracurricular activity groups must be made through the respective advisor concerned. Advisors who wish to take their clubs or other extracurricular groups o trips off campus must receive prior approval from the Dean of Student Life. Such approval may be requested by submitting Extracurricular Trip Memorandum form, in duplicate, to the Dean of Student Life one (1) week prior to the scheduled trip. The advisor should also sign an Advanced Notice of Authorized Absence form for each student who will be absent from any class while on the extracurricular trip. Each student is responsible for filling out this form and presenting it to each instructor one (1) week prior to the scheduled trip. Transportation by Associated Students vehicle is sometimes available. Request for such transportation may be made to the receiving department manager or the business manager of the Associated Students. Forms for extracurricular activities trips may be obtained from the secretary to the Dean of Student Life. Responsibilities of Advisors on Extracurricular Trips Instructors or advisors who take extracurricular student activity groups on off-campus trips are responsible for: 1. Obtaining written approval for the trip from the appropriate college administrator one (1) week prior to the scheduled trip. 2. Submitting required forms as listed above. 3. Supervising the conduct of all students during the entire trip. Such conduct will at all times conform to the Santa Monica College Guidelines for Student Conduct, as outlined in the Santa Monica College Handbook. 4. Assuring that each student going on extracurricular activity trips possesses a current Associated Students membership card. 5. Ascertaining that all drivers have current drivers have current drivers licenses and adequate automobile insurance if private vehicles are utilized for transportation. 6. Travel by private automobile may be used with the following provisions: a. That the student s automobile is in a reasonably safe operating condition. b. That the provisions of detour and frolic are complied with (this means that the students are to be given specific instructions as to time and place of departure and time and place of arrival, and that students are to proceed directly from the college or any other assigned point to the field trip site). c. Parent consent slips, also available from the secretary to the Administrative Dean, Community and Student Development, should be obtained for any student under 18 years of age. Student 18 years or over must assume the same liability provisions as were formerly observed for those students 21 or over. Liability insurance (district blanket coverage) is available to advisors while in the normal pursuit of their duties. (Replaces AR )

2 SANTA MONICA COLLEGE Student Life/Associated Students Office Club Advisor s Responsibility on Extra-Curricular Trips Full-time Advisor s Name: Ph(s): Club Name: Total number of Students attending trip: Total number of Advisors (FT/PT) attending trip: The Associated Students Board of Directors has approved the following amount of funds for the trip: $ Field-trip Destination: Ph: Field-trip Address: (Street) (City) (State) (Zip) Departure: () (Time) (Location of On/off campus) Arrival: () (Time) (Location of On/off campus) Dear Full-time Advisor: The Student Life/Associated Students Office has received notice that you are the Full-time Advisor accompanying the above named club on an off-campus trip. 1. As the Full-time (FT) Advisor accompanying the students: a. Please read and keep the attached SMC Board of Trustees Administrative Regulation 5319 regarding Extracurricular Trips. b. Please note your responsibilities in regard to students whom you accompany, student conduct and transportation arrangements. c. Further, the full-time advisor is responsible for disbursement and accounting for all college funds expended for extracurricular trips. 2. FIELD-TRIP PAPERWORK to submit, to the Student Life/A.S. Office, five (5) days before leaving on your field-trip: The following forms must be submitted to the Student Life/Associated Students Office: a. FORM this Club Advisor s Responsibility on Extra-Curricular Trips b. NON-FORM - A list of Students or Participants with SMC ID Numbers c. FORM - Release and Waiver of Liability and Indemnity Agreement d. FORM (If Applicable): Personal Vehicle Use DRIVER Form e. FORM (If Applicable): Non-SMC District Transportation PASSENGER Form f. FORM (If Applicable): Field Trip Release and Waiver (if student/participant is under 18 years of age) g. FORM (If Applicable): Release and Waiver for Early Departures The following forms must be kept in the FULL-TIME ADVISOR S possession during the field-trip: a. FORM - Conference, Retreat and Field Trip Agreement b. FORM - Medical Consent Please sign below and return this form to the Associate Dean of Student Life, Cayton Center, Room #202. Your signature on this form indicates that you have read this form, the enclosed materials, and will supervise the trip in accord with campus policies and regulations. The College appreciates your service as a Full-Time Advisor to student clubs and appreciates the commitment of your time in helping SMC students become better informed and educated through these supervised activities. Full-Time Advisor Name (print) Full-Time Advisor Signature

3 Santa Monica Community College District RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT The undersigned, (Name): SMC ID# hereby voluntarily participates in a trip to on (): organized by persons associated with the Associated Students of Santa Monica College, an organization authorized by the SANTA MONICA COMMUNITY COLLEGE DISTRICT, which persons have formed what is known as the Associated Students of Santa Monica College. The Associated Students of Santa Monica College is intended to promote the intellectual, social, educational, and cultural welfare of the students of Santa Monica College. The undersigned expressly understands, acknowledges and agrees that participation in this event, or any other event or activity organized or sponsored by the Associated Students of Santa Monica College is strictly voluntary, is not a required condition of enrollment with the SANTA MONICA COMMUNITY COLLEGE DISTRICT, and is not in any way a school sponsored activity. (LOCATION of field trip will be abbreviated as.) In consideration of being permitted to participate in, and travel to and from, the Associated Students of Santa Monica College excursion to. The undersigned, (Name): hereby release the Santa Monica Community College District, its agents and employees, from any and all liability to the undersigned for any loss or damage on account of injury or death to the undersigned which occur traveling to or from, or any time during the excursion to, and which are caused by the negligence or carelessness of the District, its agents and employees, which, in any way, arise during the excursion to. I further consideration of being permitted to travel to and from or otherwise participate in the Associated Students of Santa Monica College excursion to, the undersigned hereby agrees to the following: 1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENTANTS NOT TO SUE THE SANTA MONICA COMMUNITY COLLEGE DISTRICT, its Directors, officers, employees and agents (hereinafter releases ) from any and all liability to the undersigned, his/her personal representative assigns, heirs, and next of kin for any loss or damage, any and all claims or demands therefore on account of injury to the person or property resulting in injury or death of the undersigned is traveling to and from, in, upon, about or during any portion of the excursion to described herein. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMINFY AND SAVE AND HOLD HARMLESS THE RELEASES from any loss, liability, damage or cost that may arise involving the undersigned in traveling to or from, in, upon, about or during the excursion to, whether caused by the negligence or carelessness of releases or otherwise. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence or carelessness or releases or otherwise while traveling to or from, in about, upon or during the excursion to. THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER, AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California, and that is any portion therefore is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY, KNOWINGLY AND WILLINGLY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made. Club Name: Full-Time Advisor: I have read this release: Print Name Signature I am the parent/legal guardian of the participant who is under 18 years of age to whom the above statements apply and I am executing this agreement. Parent/Legal Guardian Printed Name & Signature

4 MEDICAL CONSENT (FT Advisor keeps this form while attending the Field-Trip.) In the event of any medical emergency, I grant to the Santa Monica College District or any of its representatives on the trip, the full authority to take any action deemed necessary to protect my health and safety at my expense. This authority shall include but is not limited to, placing the participant under the care of a doctor or in a hospital at any place for medical examination and/or own expense if such return is deemed necessary after consultation with medical authorities. Name of Student: SMC ID#: Club: A.S. #: Trip to: of Trip: I am 18 years of age or older and I am the participant. Month & Year of Birth: I am the parent/legal guardian of the participant who is under 18 years of age to whom the above statements apply and for whose benefit I am executing this consent. I have read this consent and I understand its terms. I execute it voluntarily and with full knowledge of its significance. I have completed the EMERGENCY INFORMATION section below with correct information. Print Name and Signature of Participant or Legal Guardian Street Address City Zip Code Home Phone # Personal Cell Phone # EMERGENCY INFORMATION Complete All Information In case of emergency please contact: (full name) Relationship: Contact Phone#(s): My Medical Insurance Carrier: Policy #: I am currently taking the following Medication(s) & dosage(s) [prescription and non-prescription]:

5 Conference, Retreat and Field Trip Agreement (Full Time Advisor keeps this form while attending the Field-Trip.) Club Name: Event: FT Advisor: (s): Trip to: City/State of Trip: I understand that I am attending this conference, retreat, or field trip as a representative of Santa Monica College and that my expenses are paid by the students of Santa Monica College. I understand that I am to conduct myself in a responsible manner and agree to the following: 1. No Drinking (even if I am over 21 years of age) 2. No Drugs 3. No Rowdy or Lewd Behavior 4. No Phone Calls, Movie Rentals, Food or Beverages Charged to your room. 5. No behavior that will endanger myself or others. 6. Nor will I leave the facilities in which I am lodged or premises of the event without the written, personal permission of the Full-Time Advisor supervising the trip. I understand that violation of this agreement may result in my immediate return to my home at my own expense. I also understand that I may be subject to penalties administered by the Santa Monica College Student Judicial Affairs Department (Disciplinarian Office). Student Name (print): SMC ID#: Student Signature: : I am the parent/legal guardian of the participant who is under 18 years of age to whom the above statements apply and I am executing this agreement. Parent/Legal Guardian Printed Name & Signature

6 Personal Vehicle Use - DRIVER Name: Phone: SMC ID# Driver s License #: Expiration : of Birth: Year & Make of Auto: Vehicle License #: Insurance Carrier: Phone: Liability Limits: Policy #: Exp. : I certify that the above information is correct and that the insurance coverage is in force. I understand that while driving my personal vehicle in the course of my duties with the Santa Monica College that I must have liability insurance coverage and a valid driver s license as required by the State of California. I agree to advise the college, in writing, of any changes in the above information. I further certify that the above vehicle is mechanically safe. If you drive your personal automobile while on college business and you are involved in an accident, by law your liability insurance policy is used first. The college liability coverage would be used only after your limits have been exceeded. The college does not provide comprehensive or collision coverage to your vehicle. All persons driving on college business will: 1. follow the most direct route; 2. avoid unnecessary stops; 3. transport only authorized persons, no guests; 4. transport no more than nine (9) students/staff, no matter if the vehicle can accommodate more students/staff; 5. ensure that all occupants use seat belts required by the State of California. Attach a photocopy of the following documents: 1. Proof of Insurance provided by your automobile insurance company that indicates expiration date of insurance, and 2. your valid driver s license. The Santa Monica College may obtain a driving record check from the California Department of Motor Vehicles. Field Trip to: of Trip: City/State of Field Trip: Club Name: Purpose: Driver s Name (print) Driver s Signature Full-Time Advisor Name (print) FT Advisor Signature

7 Non-SMC District Transportation - PASSENGER The undersigned passenger hereby acknowledges and understands that the Santa Monica College District is NOT providing transportation to Santa Monica College sponsored activities and that it is the responsibility of the undersigned to arrange for transportation. The undersigned passenger acknowledges and understands that the driver is not driving on behalf of or as an agent of the Santa Monica College District. Further, the undersigned passenger understands that the Santa Monica College District has not verified the driving record of the driver or the mechanical condition of the vehicle. It is fully understood that the Santa Monica College District is in no way responsible, nor does the Santa Monica College District assume liability, for any injuries or losses resulting from this NON- Santa Monica College District sponsored transportation. Although the Santa Monica College District may assist in coordinating the transportation and/or recommend travel time, routes, or caravanning to and/or from this event, I fully understand that such recommendations are not mandatory. Passenger Name (Print): Passenger Signature: Field-Trip To: SMC ID#: : of Field-Trip: City/State of Field-Trip: Club Name: Full-Time Club Advisor Name (Print): Full-Time Club Advisor Signature: : I am the parent/legal guardian of the participant who is under 18 years of age to whom the above statements apply and I am executing this agreement. Parent/Legal Guardian Printed Name & Signature

8 FIELD TRIP FORM RELEASE and WAIVER for EARLY DEPARTURES The undersigned agrees to hereby hold harmless and releases and forever discharges the Board of Trustees of the Santa Monica Community College District, and the officers and employees thereof, from any and all claims and demands whatsoever which the undersigned, and any of them, or any third persons, and the representatives thereof, or any persons acting on their behalf have or may have against and the said Board of Trustees, or their officers or employees by reason of accident, illness, injury to or death of any person or persons, or damage to or loss or destruction of any property arising or resulting directly or indirectly from participation in the aforementioned field trip and occurring during said participation or any time subsequent thereto. The undersigned has been given permission by the officers of the Santa Monica College to participate in the following field trip on the following dates: Field Trip to: (s) of Trip: City/State of Field Trip: Club Name: Full Time Advisor: Reason for leaving: The undersigned furthermore has requested to depart early from the above said field trip and agrees to assume full individual responsibility upon such departure. of Departure:, Time of Departure: am / pm Print Name Signature Signed I am the parent/legal guardian of the participant who is under 18 years of age to whom the above statements apply and I am executing this release and waiver. Parent/Legal Guardian Printed Name & Signature

9 Santa Monica College - Field Trip Release and Waiver Participants under eighteen (18) years of age. This waiver is required under Santa Monica College, Administrative Regulation Code The undersigned, and in the event the undersigned is under eighteen (18) years of age, the undersigned s parents or legal guardians, for and in consideration of granting permission of the Board of Trustees of Santa Monica Community College District for the undersigned to participate in the following field trip: Field Trip to: of Trip: City/State of Field Trip: Club Name: Full Time Advisor: Hereby hold(s) harmless and release(s) and forever discharge(s) the Board of Trustees of the Santa Monica Community College District, and the officers and employees thereof, either in their individual capacities or by reason of their relationship to the said Board of Trustees, and their successors, from and all claims and demands whatsoever which the undersigned, and any of them, or any third persons, and the representatives thereof, or any persons acting on their behalf have or may have against the said Board of Trustees, or their officers or employees by reason of any accident arising or resulting directly or indirectly from participation in the aforementioned field trip and occurring during said participation or any time subsequent thereto. d this day of, 20. Student Name (print) Signature Mother or Guardian (print) Signature Father or Guardian (print) Signature

Field Trip, Offsite Tutoring and Transportation Policy

Field Trip, Offsite Tutoring and Transportation Policy Field Trip, Offsite Tutoring and Transportation Policy This policy is intended to protect the safety of School on Wheels, Inc. (SOW) students and volunteers while participating in field trips, offsite

More information

Please type or print. Name: Last First Middle. Program: For Participants in State University of New York Administered Overseas Academic Activities

Please type or print. Name: Last First Middle. Program: For 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 Please type or print. Name: Last First Middle Program: Location Abroad Term Abroad For Participants in State

More information

APPENDIX B. Adult Check here if the intern is an adult. Minor Check here if the intern is a minor.

APPENDIX B. Adult Check here if the intern is an adult. Minor Check here if the intern is a minor. APPENDIX B Adult Check here if the intern is an adult. Minor Check here if the intern is a minor. IMPORTANT: ALL ADULT INTERNS AGREE: [Insert Name] ( Intern ), by my own request, desire to participate

More information

Motorcycle RiderCourse WAIVERS

Motorcycle RiderCourse WAIVERS Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State

More information

All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted.

All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted. Independent Study Physical Education (I.S.P.E.) The following items must be on file before your Independent Study application is complete. (1) Complete the online I.S.P.E. contract (keep a copy for your

More information

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points)

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points) Off Campus Trip LENS Check Packet The LENS check packet is required when a student is driving their personal car or driving a rental car to a University approved activity. Return the completed packet to

More information

TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET

TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET 1. TAMU-COMMERCE GENERAL WAIVER All camp participants must complete the TAMU-C General Waiver. 2. CAMPUS RECREATION (MRC & ABE) WAIVER If your camp is utilizing

More information

TEXAS A&M INTERNATIONAL UNIVERSITY

TEXAS 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 information

Delaware, Dubuque and Jackson County Regional Transit Authority. 7600 Commerce Park Dubuque, IA 52002 1 800 839 5005 www.rta8.org

Delaware, Dubuque and Jackson County Regional Transit Authority. 7600 Commerce Park Dubuque, IA 52002 1 800 839 5005 www.rta8.org Delaware, Dubuque and Jackson County Regional Transit Authority 7600 Commerce Park Dubuque, IA 52002 1 800 839 5005 www.rta8.org How it works: Pick up a volunteer drivers handbook (see page 3 for where

More information

Participation in Studies in Foreign Country (Behavior Contract)

Participation in Studies in Foreign Country (Behavior Contract) Participation in Studies in Foreign Country (Behavior Contract) This form is to be completed by any individual who desires to participate in a Study Abroad Program. Participant, as used in this document,

More information

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP: Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as

More information

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE 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 information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition. California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

More information

Student Transportation Policies and Procedures

Student Transportation Policies and Procedures Revised 7/19/12 Student Transportation Policies and Procedures Introduction The safety of our students at Wilmington University is very important. With this in mind, Wilmington University has instituted

More information

Austin Community College Study Abroad Application Packet Scotland May 2006 APPLICATION COVER PAGE and CHECK LIST

Austin Community College Study Abroad Application Packet Scotland May 2006 APPLICATION COVER PAGE and CHECK LIST APPLICATION COVER PAGE and CHECK LIST Student Name Program Name: BUSG 1191 International Study Tour Departure Date: May 13, 2006 Return Date: May 21, 2006 Faculty Leaders: Fred Baird Destination Countries:

More information

Math + Leadership Camp at CSUSM Registration Forms

Math + Leadership Camp at CSUSM Registration Forms Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of

More information

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 ASSUMPTION AND ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY WAIVER 1. ALL OF THE UNDERSIGNED, DO HEREBY AFFIRMATIVELY

More information

San Antonio Tennis Academy

San Antonio Tennis Academy A Six Sigma Standard- The relentless and rigorous pursuit for near perfection 2014 Summer Tennis Camps at San Antonio Christian School Bronze Summer Camp- (ages 8-14 & intro-intermediate High School) 1

More information

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach)

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) (Agency/Instructor/Coach) hereby agrees to defend, indemnify and

More information

UNIVERSITY OF CONNECTICUT UNDERGRADUTE EDUCATION FIELD TRIP POLICY

UNIVERSITY OF CONNECTICUT UNDERGRADUTE EDUCATION FIELD TRIP POLICY Field Trips are an important component of the experiential learning advocated in the University s academic plan for undergraduate education. In order to promote the success and safety of all involved in

More information

Youth Camp Civic Center

Youth Camp Civic Center Youth Camp Civic Center Household ID # Please circle the session(s) that your child(ren) will attend Session One June 8- June 12 Session Two June 15 June 19 Session Three June 22 June 26 Session Four June

More information

Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E

Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E TAKE 435N EXIT 411B TO STATE AVE WEST EXIT 13B COMING 70W TAKE 435N EXIT 411B TO

More information

Annual Field Trip Forms

Annual Field Trip Forms Annual Field Trip Forms Dear Parents: We are excited about the field trips planned for this year. They have a significant role in your child s education. In an effort to provide safe field trips for your

More information

AIRCRAFT RENTAL AGREEMENT

AIRCRAFT RENTAL AGREEMENT AIRCRAFT RENTAL AGREEMENT First Name: Last Name: Street Address: City: State: Zip: Home Phone: ( ) Cell Phone: ( ) Email: Date of Birth: / / Under Age 18 IN CASE OF EMERGENCY NOTIFY: Name: Telephone: Relationship:

More information

How To Volunteer With The City Of Chicago Animal Control

How To Volunteer With The City Of Chicago Animal Control City of Chicago Rahm Emanuel, Mayor Department of Animal Care & Control NOTICE OF VOLUNTEER OPPORTUNITY NOTICE OF VOLUNTEER OPPORTUNITY Animal Care & Control - UNPAID The Department of Animal Care & Control

More information

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ), the undersigned student, wish to participate in a study abroad Program offered by Saint

More information

MEMBERSHIP/BOAT SUPPORT APPLICATION

MEMBERSHIP/BOAT SUPPORT APPLICATION MEMBERSHIP/BOAT SUPPORT APPLICATION Family memberships include no more than two adults per household and their unmarried rowing children under the age of 21 (or currently enrolled in school up to age 23).

More information

Travel Grant Application Fall 2015 October 23 Deadline

Travel Grant Application Fall 2015 October 23 Deadline Travel Grant Application Fall 2015 October 23 Deadline The USUAA Student Travel Scholarship program was created by USUAA Student Government and is funded entirely by student fees. Scholarships are awarded

More information

MINORS ON CAMPUS. 1. Supervision, Background Investigations, Compliance with Laws and Rules:

MINORS ON CAMPUS. 1. Supervision, Background Investigations, Compliance with Laws and Rules: MINORS ON CAMPUS Required Provisions in Affiliation Agreements/Contracts [Appendix D] 1. Supervision, Background Investigations, Compliance with Laws and Rules: (A) Licensee shall, at licensee s sole cost

More information

Volunteer Driver Application Form

Volunteer Driver Application Form Road to Recovery Volunteer Driver Application Form Please Print Name: Street Address: City State Zip: Other Address Information/ Email: Home Phone: Work Phone: Date of Birth: Occupation: Emergency Contact

More information

Indianapolis Motor Speedway 4790 West 16 th Street Indianapolis IN 46222 Ticket Office 317.484.6700 www.brickyard400.com

Indianapolis Motor Speedway 4790 West 16 th Street Indianapolis IN 46222 Ticket Office 317.484.6700 www.brickyard400.com Indianapolis Motor Speedway 4790 West 16 th Street Indianapolis IN 46222 Ticket Office 317.484.6700 www.brickyard400.com From the Airport: Take I-465 north to exit 16A. Turn right at the top of the exit

More information

City of Holly Springs Citizen s Police Academy

City of Holly Springs Citizen s Police Academy City of Holly Springs Citizen s Police Academy City of Holly Springs Police 3235 Holly Springs Parkway Holly Springs, GA. 30115 Officer Greg Bettis 770.721.7526 dbettis@hollyspringsga.us 1 The Holly Springs

More information

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures:

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures: INSTRUCTIONS FOR COMPLETING REGISTRATION 1. Print out the Waiver of Liability, Medical Release Form and Participant Information Sheet attached to this document 2. Fill out the forms completely with necessary

More information

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION In keeping with its commitment to community policing, the Mountlake Terrace Police Department offers qualified persons the opportunity

More information

Northstar Travel & Associates

Northstar Travel & Associates Northstar Travel & Associates TRAVEL BOOKING & PASSENGER REQUEST FORM (Please use 1 application form for each participant) NOTE: Please include a photocopy of the first page (ie. photo-page ) of your passport

More information

Liability Waiver and Release. Name: Phone Number: E- mail:

Liability Waiver and Release. Name: Phone Number: E- mail: Liability Waiver and Release Name: Phone Number: E- mail: I am the person whose name appears on this form and all information is correct to the best of my knowledge. In addition, I understand that Pearl

More information

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information

More information

INTERNATIONAL LEADERSHIP OF TEXAS

INTERNATIONAL LEADERSHIP OF TEXAS INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS

More information

POLICY INVOLVING VEHICLE USE ON OFFICIAL COLLEGE BUSINESS AUTOMOBILES & OTHER MOTORIZED VEHICLES Last update: August 9, 2011

POLICY INVOLVING VEHICLE USE ON OFFICIAL COLLEGE BUSINESS AUTOMOBILES & OTHER MOTORIZED VEHICLES Last update: August 9, 2011 POLICY INVOLVING VEHICLE USE ON OFFICIAL COLLEGE BUSINESS AUTOMOBILES & OTHER MOTORIZED VEHICLES Last update: August 9, 2011 INTRODUCTION: Rollins College has many faculty, staff and students whose responsibilities

More information

Lighthouse Christian Academy

Lighthouse Christian Academy Lighthouse Christian Academy APPLICATION - FORM 1 of 9 Term 20-20 Date Office Use Only Interviewed By: Status: STUDENT INFORMATION (Please print or type) Name (Last) (First) (Middle) Address (Street) (City)

More information

Personal History Statement Application for Law Enforcement Explorer

Personal History Statement Application for Law Enforcement Explorer Name: Date Applied: Personal History Statement Application for Law Enforcement Explorer The Plano Police Department Explorer Post 911 909 14 th Street Plano, Texas 75086-0358 Instructions Read these instructions

More information

PLEASE READ ALL INFORMATION CAREFULLY

PLEASE READ ALL INFORMATION CAREFULLY Eligibility and Application Information Global Scholars Study Abroad Program 2016 SERVICE LEARNING Costa Rica and Nicaragua PLEASE READ ALL INFORMATION CAREFULLY Travel Dates: April 25 - May 6, 2016 (Dates

More information

Elk Grove Park District Preschool Date

Elk Grove Park District Preschool Date Class For Office Use Only New/Readmit Birth Cert. In/Out of Dist Release Medical Elk Grove Park District Preschool Date Name of Child M F Date of Birth Age Primary Phone # Address City Zip Primary e-mail:

More information

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity:

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity: University of California, Irvine Campus Recreation CLUB SPORTS VOLUNTEER COACH AGREEMENT PLEASE PRINT LEGIBLY Name of Sport Club: Year: Name of Coach: Home Address: Daytime Phone #: Cell Phone #: E-mail

More information

Release of Liability. Printed Name of Participant:

Release of Liability. Printed Name of Participant: 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 information

RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT

RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT In consideration, the receipt and sufficiency of which is hereby acknowledged, for being allowed entry into and participation

More information

UCI SUMMER SESSION 2012 TRAVEL-STUDY PROGRAMS ENROLLMENT PACKET CHECKLIST

UCI SUMMER SESSION 2012 TRAVEL-STUDY PROGRAMS ENROLLMENT PACKET CHECKLIST ENROLLMENT PACKET CHECKLIST Thank you for your interest in UCI Summer Session Travel-Study Programs! Enrollment packets that are not 100% complete will not be processed. You must sign and date all portions

More information

[;)f. California State University Student Travel. Executive Order No. 1041

[;)f. California State University Student Travel. Executive Order No. 1041 THE AL FORNIA STATE UNIVERSITY O FFICE OF THE-C l-!ancellor BAKERSFIELD May 29,2009 CHANNEL ISLAN D S CI-IlCO MEM O RAN DUM DOMINGUEZ I-IILLS EAST BAY TO: CSU Presidents FROM: Charles B. Reed /} Chancellor

More information

I UNDERSTAND THAT THESE RISKS MAY RESULT IN INJURY OR EVEN DEATH.

I UNDERSTAND THAT THESE RISKS MAY RESULT IN INJURY OR EVEN DEATH. CORNELL COLLEGE S RELEASE, WAIVER AND INDEMNIFICATION AGREEMENT FOR NON-EMPLOYEES ATTENDING FOR CREDIT ACTIVITIES OFFERED BY NON- EIIA MEMBER INSTITUTIONS OR OTHER THIRD PARTIES OR INDEPENDENT STUDY OR

More information

Georgia Tech North Ave. NW Atlanta Ga. 30332

Georgia Tech North Ave. NW Atlanta Ga. 30332 Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways

More information

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ) the undersigned student wish to participate in a study abroad Program offered by Saint Louis

More information

GW Pre-College Program for Ameson American High School Programs 2015 Application

GW Pre-College Program for Ameson American High School Programs 2015 Application GW Pre-College Program for Ameson American High School Programs 2015 Application Note: Please print your name as given in your passport Last/Family Name First Name Middle Name Permanent Address City State/Province

More information

Participant Application for Short-term Faculty-led Programs

Participant Application for Short-term Faculty-led Programs Participant Application for Short-term Faculty-led Programs DATE PERSONAL INFORMATION Name as it appears on your passport: (last) (first) (middle) Gender: Male Female Date of Birth: / / Do you smoke? Yes

More information

Student Government Association Funding Request Form Individual Student

Student Government Association Funding Request Form Individual Student Date of Request: Date Received: Contac t Information Student s Name: G Number: Contact Phone: Contact Email: Academic Advisor: Advisor Phone: Travel Request Advisor Email: Name of Conference/Competition

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male

More information

Santa Barbara Unified School District Independent Study Physical Education (ISPE) Criteria and Guidelines

Santa Barbara Unified School District Independent Study Physical Education (ISPE) Criteria and Guidelines Criteria and Guidelines To qualify for ISPE a student must have a Grade Point Average (GPA) of 2.0 and no conduct violations. In addition, the student must meet the following criteria: The student is an

More information

2015-16 Insurance Information Insurance coverage

2015-16 Insurance Information Insurance coverage 2015-16 Insurance Information Insurance coverage 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 information

RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME

RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME UNDER 18 YEARS (SIGNED AND INITIALED BY PARTICIPANT AND

More information

Seville, Spain Summer 2015

Seville, Spain Summer 2015 STUDY ABROAD PARTICIPANT AGREEMENT This Short-Term Study Abroad Program Agreement Packet contains the legally binding documents that will guide and inform students of certain required policies and procedures

More information

VOLUTEER LEADERS SAINT CHRISTOPHER JOURNEYS, LLC LIMITATION OF LIABILITY STATEMENT

VOLUTEER LEADERS SAINT CHRISTOPHER JOURNEYS, LLC LIMITATION OF LIABILITY STATEMENT VOLUTEER LEADERS Saint Christopher Journeys LLC uses the services of volunteer leaders for the journeys. Volunteer leaders do not pay for their participation in the journey. In the case of international

More information

Pittsfield Family YMCA: Personal Training Services

Pittsfield Family YMCA: Personal Training Services Pittsfield Family YMCA: Personal Training Services I would like to purchase the following Client s Name personal training package with personal trainer : Trainer s Name 1 Session, $40 2 Sessions, $80 5

More information

RELEASE, WAIVER OF LIABILITY, HOLD-HARMLESS AGREEMENT AND COVENANT NOT TO SUE

RELEASE, WAIVER OF LIABILITY, HOLD-HARMLESS AGREEMENT AND COVENANT NOT TO SUE RELEASE, WAIVER OF LIABILITY, HOLD-HARMLESS AGREEMENT AND COVENANT NOT TO SUE This Release, Waiver of Liability, Hold-Harmless Agreement and Covenant Not to Sue (hereinafter Agreement ) was read, understood

More information

Motor Vehicle Policy

Motor Vehicle Policy Table of Contents I. Overview............................................................. 3 II. Procedures and Responsibilities.......................................... 4 III. Accident Procedures for

More information

Bartow County C.E.R.T.

Bartow County C.E.R.T. Dear Applicant, I would like to take this opportunity to thank you for your interest in the Community Emergency Response Team. The CERT Program is presented by the Bartow County Emergency Management Agency

More information

Selah Fire Department Yakima County Fire District # 2

Selah Fire Department Yakima County Fire District # 2 Volunteer Application Packet 2014 Web Application 206 West Fremont Avenue - Selah, Washington 98942 Chief Gary Hanna Business Phone (509) 698-7310 Fax (509) 698-7317 Volunteer Firefighter Thank you for

More information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information TARLETON SPORTS MEDICINE Student-Athlete Medical Information TARLETON STATE UNIVERSITY ATHLETICS DEPARTMENT Box T-0080 Stephenville, TX 76402 254-968-9178 254-968-9674 FAX www.tarletonsports.com Dear Parent

More information

INDEMNITY AND HOLD HARMLESS AGREEMENT

INDEMNITY AND HOLD HARMLESS AGREEMENT MIAMI-DADE COUNTY, FLORIDA MEDICAL EXAMINER DEPARTMENT NUMBER ONE ON BOB HOPE ROAD MIAMI, FLORIDA 33136-1133 (305) 545-2400 INDEMNITY AND HOLD HARMLESS AGREEMENT A. (Insert the name) (the Agency) agree(s)

More information

Vehicle Use Guidelines

Vehicle Use Guidelines Administrative Services Operational Guidelines Vehicle Use Guidelines Adopted July 1, 2011 Revised August 7, 2013 North Idaho College Administrative Guidelines: Vehicle Use (Revised August 7, 2013) Contact:

More information

Panama: Beyond the Classroom Application for Participation

Panama: Beyond the Classroom Application for Participation Panama: Beyond the Classroom Application for Participation IDH 4200 Honors Geographical Perspective IDH 4000 Major Works Major Issues Fall 2010 Travel Dates: December 11 December 19 Trip Overview and Course

More information

PRECOLLEGE PERSPECTIVE 2015 RELEASE, WAIVER AND INDEMINIFICATION

PRECOLLEGE PERSPECTIVE 2015 RELEASE, WAIVER AND INDEMINIFICATION PRECOLLEGE PERSPECTIVE 2015 RELEASE, WAIVER AND INDEMINIFICATION Ringling College of Art and Design requires all PreCollege Perspective participants to sign a Release, Waiver and Indemnification Agreement.

More information

2016 LakeRacer LLC Desert Storm Event Registration Forms. POKER RUN EVENT TERMS AND CONDITIONS

2016 LakeRacer LLC Desert Storm Event Registration Forms. POKER RUN EVENT TERMS AND CONDITIONS POKER RUN EVENT TERMS AND CONDITIONS The registration fees: Each entry includes Two poker hands, two t-shirts, two adult entries for the registration party, awards banquet, prize drawings, and an aerial

More information

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development

More information

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION 2015-2016 SEASON MEMBERSHIP APPLICATION MEMBER INFORMATION: BACK TAG # ISSUED: MEMBER NAME: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CEL #: E-MAIL ADDRESS: (Please send newsletter via: Mail E-Mail ) DATE

More information

Indemnity to ERC, and to Minor Release

Indemnity to ERC, and to Minor Release Universal Release of Liability This is a release of claims, a waiver of liability, an assumption of risk, and an indemnity agreement. By signing this document, you will irrevocably waive and release certain

More information

THE GYM, LLC MEMBERSHIP AGREEMENT

THE GYM, LLC MEMBERSHIP AGREEMENT Member s Name: THE GYM, LLC MEMBERSHIP AGREEMENT For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned ( Member ) and THE GYM, LLC, a Colorado

More information

COC-Insurance Requirements Page 1 of 9

COC-Insurance Requirements Page 1 of 9 CITY OF CONCORD INSURANCE AND INDEMNIFICATION REQUIREMENTS (The 1 st two pages provide basic insurance requirements information.) Insurance Required: See below Sample in Contract Limits of Coverage: Additional

More information

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

More information

Effective: July 10, 1995 Last Revised: August 2, 2010. Rev. 8/2/2010. Policy: Vehicle Use and Driver Responsibilities

Effective: July 10, 1995 Last Revised: August 2, 2010. Rev. 8/2/2010. Policy: Vehicle Use and Driver Responsibilities Effective: July 10, 1995 Last Revised: August 2, 2010 Xavier University Risk Management Flynn Hall ML 7211 Ph (513) 745-2090 Fax (513) 745-2092 XAVIER UNIVERSITY VEHICLE USE AND DRIVER RESPONSIBILITIES

More information

PHOTOGRAPHY/VIDEO SERVICES AGREEMENT

PHOTOGRAPHY/VIDEO SERVICES AGREEMENT PHOTOGRAPHY/VIDEO SERVICES AGREEMENT This Agreement is entered into as of the day of, 201_, between, Villanova University ( Villanova ) and, ( Photographer ). 1. Services. (a) Description and Requirements.

More information

UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) I. RELEASE

UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) I. RELEASE UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) This Release and Waiver of Liability Agreement is entered into by all Participants

More information

IES ABROAD CUSTOMIZED PROGRAMS

IES ABROAD CUSTOMIZED PROGRAMS IES Abroad- Institute for the International Education of Students 33 North LaSalle, 15 th Floor, Chicago, IL 60602 WAIVER FOR STUDENTS OF CONTRACTED INSTITUTIONS IES ABROAD CUSTOMIZED PROGRAMS STUDENT

More information

2014 Fort Worth Regional Science and Engineering Fair, University of Texas at Arlington, RadioShack. Media Release Form

2014 Fort Worth Regional Science and Engineering Fair, University of Texas at Arlington, RadioShack. Media Release Form 2014 Fort Worth Regional Science and Engineering Fair, University of Texas at Arlington, RadioShack Media Release Form I hereby consent to and authorize the use and reproduction by Fort Worth Regional

More information

NEW STUDENT REGISTRATION

NEW STUDENT REGISTRATION NEW STUDENT REGISTRATION High Performance: Academy Prep: Early Childhood: $20.00 registration fee (includes 2 Academy T-shirts) $20.00 registration fee (includes 2 Academy T-shirts) $10.00 registration

More information

PARTICIPANT APPLICATION & RELEASE. * For verification purposes only pursuant to 18 U.S.C. 2256 et seq.

PARTICIPANT APPLICATION & RELEASE. * For verification purposes only pursuant to 18 U.S.C. 2256 et seq. PARTICIPANT APPLICATION & RELEASE * For verification purposes only pursuant to 18 U.S.C. 2256 et seq. Have you ever been through a major hardship/tragedy? (hurricane, tornado, fire, earthquake, major

More information

1. Individuals requesting the street closure must be 21 years of age or older and be a resident of the street to be closed.

1. Individuals requesting the street closure must be 21 years of age or older and be a resident of the street to be closed. TO: FROM: SUBJECT: COSTA MESA RESIDENTS DANIEL K. BAKER, ASSISTANT TO THE CEO JULY 4 TH BLOCK PARTY AND STREET CLOSURE REQUEST Twice during the year (July 4th and Labor Day), Costa Mesa residents may request

More information

PEACE DALE SHOOTING PRESERVE RELEASE, WAIVER OF LIABILITY & INDEMNITY AGREEMENT

PEACE DALE SHOOTING PRESERVE RELEASE, WAIVER OF LIABILITY & INDEMNITY AGREEMENT PEACE DALE SHOOTING PRESERVE RELEASE, WAIVER OF LIABILITY & INDEMNITY AGREEMENT CAUTION: READ THIS AGREEMENT CAREFULLY BEFORE SIGNING In consideration of Peace Dale Shooting Preserve, ("PDSP") furnishing

More information

Vancouver Pescaderos Dive Club Application for Membership

Vancouver Pescaderos Dive Club Application for Membership Vancouver Pescaderos Dive Club Application for Membership Note: If applying as a family, each person is to fill an application. First application is "primary", subsequent applications in the same family

More information

Shotgun Coaching Workshop Registration and Information Package

Shotgun Coaching Workshop Registration and Information Package Shotgun Coaching Workshop Registration and Information Package Edmonton Conservation Education Centre for Excellence #88, 4003 98 th Street Edmonton, Alberta, Canada T6E 6M8 Phone: (780) 466-6682 or Toll

More information

NPSA GENERAL PROVISIONS

NPSA GENERAL PROVISIONS NPSA GENERAL PROVISIONS 1. Independent Contractor. A. It is understood and agreed that CONTRACTOR (including CONTRACTOR s employees) is an independent contractor and that no relationship of employer-employee

More information

MAINE COMMUNITY COLLEGE SYSTEM

MAINE COMMUNITY COLLEGE SYSTEM MAINE COMMUNITY COLLEGE SYSTEM HEALTH AND SAFETY Section 800.1 SUBJECT: PURPOSE: MOTOR VEHICLE PROCEDURE To promote the safe the authorized operation of motor vehicles operated on behalf, or for the benefit,

More information

2015-2016 Sport Club Coach Application

2015-2016 Sport Club Coach Application 2015-2016 Sport Club Coach Application Coach Eligibility Each 2015-2016 Sport Club Coach Application will be reviewed and approved, deferred, or denied, by the Sport Clubs Advisor or representative. An

More information

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com 2009/2010 Policy Agreement I have received a copy of the 2009/2010 studio policy and current class schedule. I agree to adhere to all studio policies as contained in this document and explained to me.

More information

New Customer Information (Please Print)

New Customer Information (Please Print) Training Only Rental & Training Basic Info New Customer Information (Please Print) Name Address Today's Date Date of Birth City State ZIP Cell Phone ( ) Email Work Phone ( ) Home Phone ( ) How did you

More information

VEHICLE USE POLICY Office of Risk & Safety November 2004

VEHICLE USE POLICY Office of Risk & Safety November 2004 VEHICLE USE POLICY Office of Risk & Safety November 2004 TABLE OF CONTENTS POLICY STATEMENT...3 POLICY...4 REASON FOR POLICY...4 ENTITIES AFFECTED BY THIS POLICY...4 WHO SHOULD READ THIS POLICY...4 RELATED

More information

FAYETTEVILLE STATE UNIVERSITY

FAYETTEVILLE STATE UNIVERSITY FAYETTEVILLE STATE UNIVERSITY TRAVEL INVOLVING STUDENTS Authority: Category: Issued by the Chancellor. Changes or exceptions to administrative policies issued by the Chancellor may only be made by the

More information

Standard Field Trip Please check one Non-Standard Field Trip

Standard Field Trip Please check one Non-Standard Field Trip Risk Management 520-2164 COLORADO SPRINGS SCHOOL DISTRICT 11 FIELD TRIP APPROVAL FORM Standard Field Trip Please check one n-standard Field Trip Submitted by: Contact Phone # School: Today s date I. Activity:

More information

Cyber Defenders Summer Camp Application Form Instructions

Cyber Defenders Summer Camp Application Form Instructions Cyber Defenders Summer Camp Application Form Instructions The Cyber Defenders Summer Camp is put on by the San Antonio College Computer Information Systems Department. It will be an overview of material

More information