Santa Monica College Administrative Regulation - Students Activities and Student Conduct (AR5319-091481) 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 5330-090176)
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
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
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]:
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
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
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
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
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 5319-091481 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