MSCC LEAD – AGGIE SHADOWS – Delegate Application
IMPORTANT! Registration opens September 1st, 2009.Please do not send in forms or payment before that date!
All mail-in applications MUST be postmarked by Tuesday, October6th, 2009.
Please Type or Print Legibly
Last Name / First Name / Preferred Name
Permanent Address / City / State / Zip Code
CurrentHigh School / Year (junior/senior) / Shirt Size: S M L XL Sex: M F
(Circle One) (Circle One)
E-mail Address
Do you request a vegetarian option? Yes No
Are you interested in housing with the Corps of Cadets? Yes No
College Major of Interest:
Please check all that apply:
□I will be driving myself and will need to park my car. I understand that I will be charged an additional $20 for a parking pass. I will include this payment with the $50 registration payment.
□I will be arriving with ______by bus/car.
Please have your parent/guardian complete this section of the application:Parent/Guardian Last Name / Parent/Guardian First Name
□I give my permission for my son/daughter to attend MSC LEAD Aggie Shadows on November1st-2nd, 2009.
Parent/Guardian Signature
Behavior Agreement
Aggie Shadows aims to give high school students the chance to experience college life first-hand while learning valuable leadership skills. To ensure that every student is receiving the full benefits of the conference, we ask that this behavior code be followed.
All delegates are expected to follow the University policies and regulations, which can be found at Delegates must not leave campus for any reason and must follow any rules or restrictions the Aggie Shadows staff implements. Additionally, being under the influence and/or use of alcohol or any kind of illegal drug is strictly prohibited. If you should fail to abide by any of these rules you will be sent home without a refund of payment.
I have clearly read and understand the Behavior Agreement stated above and I agree to be bound thereby.
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Printed Name Signature Date
RELEASE FORM PERMISSION TO TAPE OR PHOTOGRAPH
I do hereby consent and agree that MSCC LEAD at Texas A&M University has the right to utilize photographs, video, or audio of me (and/or my property) and to use these for promotional material.
I do hereby release Texas A&M University MSCC LEAD staff all rights to exhibit this work publicly or privately. I waive my rights, claims or interest I may have to control the use of my identity or likeness in the photographs, video, or audio, and agree that any uses described herein may be made without compensations or additional consideration of me.
I represent that I have read and understand the foregoing statement and am competent to execute this agreement. (Youth under 18 must have parent signature.)
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Student Name (Print)Student Signature
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Parent Name (Print)Parent Signature
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Date
□I understand that registration is not complete until I have completed all of the following steps:
- Complete the registration form (Pages 1 and 2).
- Complete wavier form. (Pages 3 and 4)
- Payment (Make checks payable to MSCC LEAD-Aggie Shadows).
- Please Mail Forms $50 Payment to: MSCC LEAD - Aggie Shadows, 1237 TAMU, College Station, Texas 77843-1237
MSCC LEAD – Aggie Shadows
STUDENT ORGANIZATION WAIVER, INDEMNIFICATION, AND MEDICAL
TREATMENT AUTHORIZATION FORM
1. EXCULPATORY CLAUSE. In consideration for receiving permission to participate in any and all activities of Aggie Shadows (herein referred to as “activity”),which is sponsored by MSCC LEAD, a Recognized StudentOrganization, (herein referred to as “organization”), I hereby release, waive, discharge, covenantnot to sue, and agree to hold harmless for any and all purposes organization, The Texas A&MUniversity System, the Board of Regents for The Texas A&M University System, Texas A&MUniversity, and their members, officers, servants, agents, volunteers, or employees (hereinreferred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands,injuries (including death), or damages, including court costs and attorney’s fees and expenses,that may be sustained by me while participating in such activity, while traveling to and from theactivity, or while on the premises owned or leased by RELEASEES, including injuriessustained as a result of the sole, joint, or concurrent negligence, negligence per se,statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply toinjuries caused by intentional or grossly negligent conduct.
2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself andothers involved with this activity, including but not limited tominor cuts and scrapes, bruises, minor strains and sprains, and I choose to voluntarilyparticipate in said activity with full knowledge that the activity may be hazardous to me and myproperty, and to the person and property of others. I acknowledge there may be physicallystrenuous activities. I know of no medical reason why I should not participate. I agree toindemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands,injuries (including death), or damages, including court costs and attorney’s fees and expenses,which may occur to myself, other participants, and third-persons as a result of my participation insaid activity, including injuries sustained as a result of the sole, joint, or concurrentnegligence, negligence per se, statutory fault, or strict liability of INDEMNITEES.
3. NO INSURANCE. I understand that RELEASEES may or may not maintain anyinsurance policy covering any circumstance arising from my participation in this activity or anyevent related to that participation. As such, I am aware that I should review my personalinsurance coverage. Organization may not carry general liability insurance to cover claimsarising from this activity so it seeks a waiver of claims as additional consideration for the right toparticipate so organization, can (a) provide the activity at the lowest possible cost to participants;and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance.
4. BINDS HEIRS. It is my express intent that this agreement shall bind the members ofmy family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I amdeceased, and shall be governed by the laws of the State of Texas.
5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, andWAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated inthis form and RELEASEES may need to respond to accidents and potential emergencysituations. Therefore, I hereby give my consent for any medical treatment that may be required,as determined by a medical professional at the medical facility, during my participation in thisactivity with the understanding that the cost of any such treatment will be my responsibility. I
agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me, even ifan INDEMNITEE has signed hospital documentation promising to pay for the treatment due to myinability to sign the documentation. I further agree to release, waive, discharge, covenant not tosue, and agree to hold harmless for any and all purposes, RELEASEES from any and allliabilities, claims, demands, injuries (including death), or damages, including court costs andattorney’s fees and expenses, that may be sustained by me while receiving medical care or indeciding to seek medical care, including while traveling to and from a medical care facility,including injuries sustained as a result of the sole, joint, or concurrent negligence,negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiverdoes not apply to injuries caused by intentional or grossly negligent conduct.
6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and representthat I have read it, understand it, and sign it voluntarily as my own free act and deed; organizationhas not made and I have not relied on any oral representations, statements, or inducements apartfrom the terms contained in this agreement. I execute this document for full, adequate andcomplete consideration fully intending to be bound by the same, now and in the future. Iunderstand I can choose not to sign this document and free myself from its terms and the
associated risks of the activity by simply not participating in the activity and choosing some otheractivity available to me that has a lower level of risk to me. I further understand this is avoluntary, extracurricular activity; therefore it is not required for me to obtain college credits andnot participating in this activity will in no way hinder my ability to obtain a degree from theuniversity. While I understand alternative activities are available to me that do not have the risksassociated with this activity I still desire to voluntarily engage in this activity.
SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS.
CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT.
SIGNED this ______day of ______, 20______.
Participant Signature: ______
Printed Name: ______
Participant’s Date of Birth: ______
Parent or Legal Guardian Signature: ______
(If Participant is under 18 years old)
Parent or Legal Guardian Printed Name: ______
(If Participant is under 18 years old)
This document should remain on file for two years after the date of event.
TAMUS-OGC-Approved 06/2007