CSUN Rebel Road Trip 2015 UNLV vs. SJSU

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1 CSUN Rebel Road Trip 2015 UNLV vs. SJSU Represent the UNLV Rebellion in San Jose, CA for the UNLV Runnin Rebels vs. SJSU Spartans. This is the final regular season basketball game of the year and we need every Rebel fan we can get to join us. #AllInAllTogether Dates: Friday, March 6 th, 2015 Sunday, March 8 th, 2015 Packages: - Scarlet and Gray Package..$75 Package Includes: T-shirt, ticket to game, bus ride and hotel room. *Special Price $60 if you sign up by Monday, February 2nd, 2015* - Ridin Rebels Package...$35 Package Includes: T-Shirt, ticket to game, bus ride Payment for package can be made via cash or check made out to Board of Regents. Due Date to sign up and pay is Friday, February 20th, 2015 at 5pm. Drop off packet and payment to the CSUN office Student Union room 316. *If payment is not made for package by Friday, February 20 th, 2015 your trip will be canceled. We are making our own Student Section in the SJSU General Admission section. Additional tickets for this section are $16 through the SJSU Ticket Office.

2 Runnin Rebels vs. San Jose State Itinerary All times are subject to change Friday, March 6 th, :00 AM: Depart UNLV Student Union 3:00 PM: (approx.): Arrive in San Jose Check into Days Inn Milpitas Saturday, March 7th, :00PM: Depart Hotel for Event Center Arena 10:00PM (approx.): Depart for Hotel Since we are sitting in a General Admission section we want to ensure that we arrive early enough to get great seats and make our own student section in their arena. Sunday, March 8th, :00AM: Depart Hotel for Las Vegas 6:00 PM (approx.) Arrive at Student Union.

3 Personal Information Name: DOB: CSUN Rebel Road Trip 2015 UNLV vs. SJSU Date: NSHE#: Address: City: State: Zip: Home Phone #: Major: Cell Phone #: Class Standing: Freshman Sophomore Junior Senior T-Shirt Size S M L XL XXL XXXL Roommate Preferences: 1 Payment Information 2 Package Choice (circle one): Scarlet and Gray Cash Amount: Check Amount: Name On Check: 3 4 Ridin Rebels Check#:

4 CSUN Student Government 3/6/15-3/8/15 UNLV / NSHE / State of Nevada Assumption of Risk / Release of Liability Form Page 1 of 2 I,, understand and agree that the Rebel Road Trip to San Jose State University, CA sponsored by CSUN involves certain risks and that regardless of the precautions taken by CSUN, some bodily injuries may occur. I understand that my actions as a Rebel Road Trip participant must be in accordance with all state and federal laws as well as NSHE/UNLV policies. I also understand that I am accountable for my actions as outlined in the Student Code of Conduct. Specific risks/hazards involved in the Rebel Road Trip to San Jose, CA, SJSU Event Center Arena, and any hotel in San Jose, CA include but are not limited to the following: 1. Transportation to and from San Jose, CA in chartered buses 2. Planned and unplanned activities relating to the basketball game between the UNLV Runnin Rebels and the San Jose State Spartans 3. Damage to personal vehicles 4. Personal injury 5. Exposure to travelers and vehicles at rest stops, fast food locations and gas stations 6. Interacting in crowds with community and students during tailgate and basketball game 7. Risk associated at overnight accommodations and interactions with your chosen roommates at San Jose, CA -based hotel 8. Consuming food provided and prepared by a third party 9. Inclement weather can impact safety (rain, cold, wind, heat). Knowing this information, in consideration of my participation in the Rebel Road trip sponsored by CSUN, I expressly and knowingly release the Board of Regents of the Nevada System of Higher Education (NSHE) on behalf of the University of Nevada Las Vegas (UNLV) and CSUN, and the State of Nevada their officers, agents, volunteers, and employees, from any and all claims and causes of action for property damage, personal injury or death sustained by me arising out of any travel or activity conducted by or under the auspices of CSUN by risks associated by this activity and/or the negligence of the sponsoring group. In addition, I understand and agree that CSUN cannot be expected to control all of the risks articulated in this form but may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. UNLV does not carry medical or accident insurance for the activities mentioned unless the participants are informed otherwise. As such, participants should review their personal insurance portfolio.

5 Finally, I voluntarily and knowingly agree to protect, hold harmless, and indemnify the Board of Regents of the Nevada System of Higher Education (NSHE) on behalf of the University of Nevada Las Vegas (UNLV) and CSUN, and the State of Nevada, their officers, agents, volunteers, and employees, against all claims, demands, or causes of action for property damage, personal injury, or death, including defense costs and attorney's fees arising out of my participation in the Rebel Road Trip sponsored by CSUN. I understand that as a University sponsored event, that the student rights and responsibilities outlined in the UNLV Code of Conduct and all other NSHE / UNLV policies apply. I have read the agreement and have willingly signed for the consideration expressed and with a full understanding of its purpose. Participant represents that he/she is eighteen (18) years of age or older and is otherwise competent to execute this agreement, or that his/her legal guardian is also signing. Print Name ID # Date of Birth Phone # Local Address Address Participant Signature Date

6 CSUN UNLV / NSHE / State of Nevada Assumption of Risk/ Release of Liability Form Page 2 of 2 If you are under 18 years of age, a parent/guardian must sign this also. By signing the document you are saying that you have read, understood, and agree to the conditions set forth in the release of liability. Parent / Guardian Signature Date Person to Notify in Case of an Emergency Name Phone # Address City Zip State Please list any special services you may require due to an existing medical condition or physical disability: ONE COPY SHOULD REMAIN ON CAMPUS IN A DESIGNATED LOCATION THAT CAN BE ACCESSED IN CASE OF EMERGENCY AND ONE COPY SHOULD ACCOMPANY THE FACULTY/STAFF ADVISOR FOR THE TRIP OR ACTIVITY

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