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Date of Trip: to
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Bellin College believes that organized off-campus activities by its students are an important part of the students’ overall learning experience. Off-campus activities do, however, involve significant risks, both to students participating in them and also to the college basedupon the manner in which students conduct themselves while off campus.
By signing this form, the above-named student agrees as follows:
- To observe standards of conduct outlined in Bellin College Code of Conduct and all Bellin College policies and procedures applicable to the student while participating in the off-campus activity referenced above (the “Activity”), understanding that such compliance is important to the success of the Activity and to the college’s willingness to permit future similar activities.
- To conform the student conduct to the standards surrounding the Activity and assume responsibility for their actions, understanding that the circumstances of an off-campus activity may require a standard of decorum which maydiffer from that applicable on campus.
- That the student does not act as an agent or representative of the college and, accordingly, shall not have or hold them out as having the power or authority to bind or create liability for the college by virtue of the student’s negligent or intentional acts or omissions.
- To assume full financial responsibility for all costs and expenses incurred by the student in connection with the Activity, including without limitation financial responsibility for damage or destruction to property of third parties.
- To obtain and maintain such health, accident, disability, hospitalization, and travel insurance as he or she may deem necessary for the Activity, and to be responsible for the costs of such insurance and any expenses not covered byinsurance.
- To immediately disclose to the college any physical or emotional conditions or problems that might impair their ability to complete the Activity, and that they hereby release the college and its trustees, officers, employees, agents, and representatives from any and all claims, demands, injuries, damages, losses, actions, causes of action, or expenses whatsoever arising out of their failure to disclose such conditions or problems.
- That participation in the Activity is entirely voluntary, and that the student is fully aware, having sought and obtained such information and advice as the student feels are necessary and appropriate, that such participation involves risk of injury and property damage, including possible short-term and long-term disability, and even death. These risks can come from causes which are many and varied, may not even be presently foreseeable, and may include negligent or intentional acts or omissions of others. The student acknowledges, accepts, and assumes all such risks, whether or not presently foreseeable and whether or not caused by the negligent or intentional acts or omissions of others, and elects voluntarily to participate in the Activity. The student releases the college and its trustees, officers, employees, agents, and representatives from any and all claims the student may have in the future, waives all such claims, and agrees not to sue the college or its trustees, officers, employees, agents, and representatives for any such claims, arising out of his or her participation in the Activity, including but not limited to claims arising out of the negligent or intentional acts or omissions of others.
Participant Signature:
Date:
IN WITNESS WHERE OF, Participant has executed this Agreement at Bellin College, 3201 Eaton Rd, Green Bay, Wisconsin on this Date:
Witness Signature
Date:
Parental/Significant Other Acknowledgement (optional for students over 18):
Parental/Significant Other Signature: