DISCLAIMER FORM
All participants, and their parents or legal guardians if under 18 years of age, must sign this disclaimer form before taking part in any off-campus event supported by The American College of Greece – Deree College (the “College”). Please download, complete and return this form to the Office of Student Affairs at least five (5) days before the event.
Statement of Purpose: The [enter name of club/organization] will participate in [enter name conference/excursion] the “Excursion”, to be held on [enter dates] at [enter name place/country].
Please read and sign the following terms and conditions,which the participant understands and is obligated to adhere to:
I, , ID# ______, understand that:
1. Participation in the Excursion is not mandatory, however I am responsible to attend all planned activities as stated in the attached program.
2. I exercise my own free choice to participate in the Excursion. I understand and assume all associated risks. I agree to assume all risk of personal injury or loss, bodily injury (including death), damage to or loss or destructions of any personal property occurring in connection with or arising out of participation in the Excursion.
3. I hereby release and discharge, indemnify and hold harmless the College, and its affiliates, member officers, agents, employees and any other persons or entities acting on their behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against all claims, demands, costs and expenses, and causes of action whatsoever, either in law or equity, arising out of or in any way connected with any loss and/or bodily injury and/or disability, arising from my participation in the Excursion.
4. The Excursion’s chaperones / escorts have no obligation in any way towards the participants of the Excursion other than the planned activities during the Excursion.
5. I will conduct myself properly and in adherence to the scheduled program at the above location as well as any other planned group excursions.
6. During the whole duration of the Excursion I am bound to behave with decency and to observe the program of the Excursion and the relevant instructions as well as to avoid any behavior or action against the purposes and the security of the Excursion.
7. The College reserves its right to take any legal measure against me in case of any infringement from my part of the laws of the state to which the Excursion may be carried out or/and any disturbance from my part of the Excursion or/and refusal to observe the instructions of the excursion’s chaperones / escorts.
8. In case of any violation of the rules of the College and of my statements included herein the corresponding sanctions provided in the College’s policies and procedures will be imposed.
9. If I am under 18 years of age, my parent(s) or legal guardian is aware of the statement of purpose and of all the above conditions and has signed this statement as an expression of their adherence to the terms.
Participant Signature Parent or Legal Guardian Signature if under 18
Contact Information
Participant Name
Cell-phone
College ID#
Contact in case of emergency
Cell-phone
Transportation/Flight Information
Departure Train/Bus/Airline carrier
Departure date Departure time
Return Train/Bus/Airline carrier
Return date Return time
Accommodation Information
Name
Phone
Address
ΑΜΕΡΙΚΑΝΙΚΟ ΚΟΛΛΕΓΙΟ ΕΛΛΑΔΟΣ – DEREE COLLEGE
Γραβιάς 6 · 153 42 Aγία Παρασκευή · Aθήνα · Tηλ.: 210 600 9800 · www.acg.edu
6 Gravias Street · 153 42 Aghia Paraskevi · Athens, Greece · Tel.: +30 210 600 9800 · www.acg.edu