UNIVERSITY FIELD ACTIVITIES NOTIFICATION DEPT COURSE

HRATCH PAPAZIAN 8TH EGYPTOLOGICAL TEMPELTAGUNG – WARSAW UNIVERSITY OF
Calisia Universitykalisz Poland Nowy Świat 4 62800 Kalisz
CHARLES UNIVERSITY OF PRAGUE FACULTY OF SCIENCE

DUGHUG CONFERENCE 6TH 8TH JULY 2005 EXETER UNIVERSITY
EARTHQUAKE ENGINEERING RESEARCH INSTITUTE OREGON STATE UNIVERSITY
EDUCATION 998504 DMA MUSIC COMPOSITION CORNELL UNIVERSITY DISSERTATION

Field Activities Notification

UNIVERSITY FIELD ACTIVITIES NOTIFICATION DEPT COURSE

University Field Activities Notification

Dept:

Course #:

Section #:

Faculty/Staff Leader:

Term:

Activity Title:

Requirements for this course include participation in activities out of the classroom, campus lab, and shops.

These activities are required by:

Alternative assignment(s) are are not available. Contact:

Schedule and Logistics for Activities:

Date(s)	Time(s)	Destination(s)	Site Activities

Fees and Expenses:

Transportation, Lodging, Food, Equipment:

Expected Site Conditions:

In the event of an emergency, I agree to follow the direction of the University faculty/staff trip leader. Initial: _____

Emergency Contact Name:

Emergency Contact Phone:

Allergies/Medical Conditions:

I authorize Cal Poly faculty or staff participating on this program to seek medical emergency treatment at the nearest hospital and/or clinic in the event I cannot make the decision myself or my emergency contact is unavailable. I authorize the administration of measures as are deemed necessary for my health and safety. Initial: _____

I agree to properly conduct myself at all times during the course of the program. I understand that any violation of University standards of conduct could lead to sanctions being imposed consistent with CSU Student Discipline Policies and Procedures. Initial: _____

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

Activity:

Date(s) and Time(s) of Activity:

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 Polytechnic State University, the Cal Poly Corporation, 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.

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 been informed and understand there remains a risk of exposure to COVID-19. I understand that regardless of any precautions taken, an inherent risk of exposure to COVID-19 will exist.

I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made by me.

Participant Signature: _______________________________

Participant Name (print): _____________________________ Date: ______________

If Participant is under 18 years of age, the following page is also required.

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

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 document, and I am signing it freely. No other representations concerning the legal effect of this document have been made by me.

____________________________________________

Signature of Minor Participant’s Parent/Guardian

____________________________________________

Name of Minor Participant’s Parent/Guardian (print)

____________________________________________ __________________

Minor Participant’s Name Date

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ERASMUS INSTITUTIONAL KEY DATA NORWEGIAN UNIVERSITY OF
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