SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT
Participation Consent Form
WAIVER RELEASE AND INDEMNITY AGREEMENT
For and in consideration of permitting (name to be filled in by participant) to participate in CBI Fall 2008 Conference approved by South Orange County Community College District at 10203 Lincoln Drive in the City of Mecca , State of California , on January 2-4, 2007 the Undersigned hereby voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, property damage or wrongful death occurring to him-/herself arising as a result of engaging or receiving instructions in said activity or any activities incidental thereto wherever or however the same may occur and for whatever period said activities or instructions may continue, and the Undersigned does for him-/herself, his/her, heirs, executors, administrators and assigns hereby release, waive, discharge and relinquish any action or causes of action, aforesaid, which may hereafter arise for him-/herself and for his/her estate, and agrees that under no circumstances will he/she or his/her heirs, executors, administrators and assigns prosecute, present any claim for personal injury, property damage or wrongful death against South Orange County Community College District or any of its officers, agents, or employees for any of said causes of action, whether the same shall arise by the negligence of any of said persons or otherwise.
IT IS THE INTENTION OF (name to be filled in by participant) BY THIS INSTRUMENT, TO EXEMPT AND RELIEVE SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE.
The undersigned, for him-/herself, his/her heirs, executors, administrators or assigns agrees that in the event any claim for personal injury, property damage or wrongful death shall be prosecuted against South Orange County Community College District he/she shall indemnify and save harmless the same South Orange County Community College District from any and all claims or causes of action by whomever or wherever made or presented for personal injuries, property damage or wrongful death.
The undersigned acknowledges that he/she has read the Waiver of Liability Notice and the foregoing three (3) paragraphs, has been fully and completely advised of the potential dangers incidental to engaging in the activity and/or instructing of CBI Fall 2008 Media Conference (activity), and is fully aware of the legal consequences of signing the within instrument.
Participant Signature Date
Parent or Guardian (Only if participant is under 18 years of age) Date
Signature of Witness (to parent or guardian’s signature) Date
READ AND SIGN BOTH SIDESSADDLEBACK COLLEGE STUDENT DEVELOPMENT
ASSOCIATED STUDENT GOVERNMENT CONFERENCE AGREEMENT
EVENT ** CBI Fall 2008 Media Conference **
**I am fully committed to attending this conference and understand that should I cancel prior to attendance, I am financially responsible for any “nontransferable” expenses incurred by ASG. Further, I understand that a “hold” will be placed on my college records until the expense is paid.**
**REMOVE BEFORE PRINTING: CUSTOMIZE STATEMENT BELOW AS APPROPRIATE**
I understand that transportation for this voluntary activity is arranged by Saddleback College and sponsored by College (enter organization name, i.e., ASG, Forensics, MUN, CNSA, etc) using commercial transportation from Saddleback College Parking Lot to/from the conference site and returning to Saddleback College. OR I understand that transportation for this voluntary activity is arranged by Saddleback College (organization name) . Travelers will meet at Saddleback College Lot 1 and travel by commercial van to LAX. The delegation will travel as a group by air to JFK, New York City, New York and by commercial ground to the conference site. The group will travel together and return by commercial ground to JFK, fly to LAX, and by commercial van to the college campus OR I understand that each participant will provide their own transportation meeting at the ( event site ) OR I understand that transportation for this voluntary activity is arranged by Saddleback College College (organization name) and sponsored by ASG. Travelers will meet at and return to John Wayne (Orange County) Airport.
I understand that I will be representing Saddleback College and agree to abide by all of the College rules, regulations, policies and procedures concerning College-sponsored events on or off campus.
These policies specifically prohibit the use or possession of any controlled substance, (i.e. alcohol or illegal drugs).
I also realize that as a conference delegate I will be expected to stay at the conference site during the entire conference schedule unless delegates take excursions as a group with the adviser. I also realize that the conference is for student government representatives only and that I am not to invite guests, family, friends and/or any “significant others” to come to the conference site. Additionally, only a family emergency or personal illness should necessitate my leaving the conference early at my own expense.
I understand that if I violate any of these regulations, I may be obligated to the ASG through the College for all conference/field trip expenses (my College records may be placed on hold until such charges are paid), and/or restricted from attending any subsequent off-campus ASG/College funded activities. Furthermore, my name will be given to the Vice President of Student Services for possible disciplinary action.
Finally, disciplinary action may include, (by Board Policy) suspension from ASG and/or more severe action involving suspension or expulsion from the College.
NAME (Print or type)
Signature Date
Emergency contact Phone
Parent’s Signature (if under 18 years of age)