Student Mentor Training
October 12th 2012
The Retention Project along with The Center for Service Learning, LEAF, and TRiO are pleased to offer, for your professional and personal development, a mentoring training. We will be inviting mentors from each mentoring program (LEAF, CSL, TRiO). We will identify and strengthen the skills you will need to become leaders within your communities at Edmonds Community College and elsewhere. We will have the opportunity to grow together as we work towards the common goal of improving the world around us.
Registration Steps:
- Read and complete the registration packet in full (including waiver of liability and photo release, unless otherwise noted) and return to Laura Caferro in the TRiO Office (MLT 120) by Thursday October 4th.
- Return completed registration packet to Laura Caferro in the TRiO Office (MLT 120) and receive reservation ticket from Laura.
- Take reservation ticket to Cashier’s Office and pay your $10.00 registration fee.
- Bring receipt of payment from Cashier’s back to Laura Caferro in TRiO MLT 120 (this acts as your confirmation for the training).
Information:
- Location: Edmonds Community College (Snohomish 304), 20000 68th Avenue W, Lynnwood, WA 98036
- Time: We will start check in at 8:30 am and will begin promptly at 8:45am. We have a fun filled day planned that should wrap at 5:30pm.
- Updates: Check the email address you provided: You will receive any necessary updates via email.
IMPORTANT:Please read and agree to the following information before deciding to register.
- All students participating in the training will be providedlunch & dinner (If you wish to make separate arrangements please contact Laura Caferro).
- No Refunds: Once a student has registered and paid for the trip, we are unable to make refunds.
- Zero Tolerance Policy: There will be no alcohol or drugs consumed while attending this training. Any student found to possess either will be dismissed from the trainingimmediately.
Fall 2012 Training Application
First Name: ______Last Name: ______
Student ID #: ______
Which program are you a part of? (circle one): LEAF TRiO CSL/ELL/Indian Education
Email: ______
Phone #: ______Alt Phone #:______
Do you have any health concerns or accommodation needs (e.g. disability, asthma, insect allergy)? ______
______
Do you have any food allergies? ______
______
What is your favorite candy?:______
By signing below you acknowledge that you have reviewed and agree with the terms of the posted liability waiver, and that you will follow the safety instructions of the volunteer organizers of this event. Unless otherwise indicated, you also agree with the terms of the posted photo release waiver.
Signature: ______Date: ______
INFORMED ACKNOWLEDGEMENT OF HAZARDS AND RISKS
CONNECTED WITH PARTICIPATION IN ACTIVITY
Please Read Carefully and Be Sure
You Understand Before You Sign
W A R N I N G
Participation in the activity or class, ______, may involve injury or risk of some type to either yourself or others. Such risk or injury can include, but is not limited to, falls or trips; slips; sprains; fractures; bruises; scratches, tears, or other damages to clothing or personal possessions; dizziness; fatigue; shortness of breath; pain; and interaction with other participants. Any injury can impair one’s general physical and mental health and hinder one’s future ability to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life. It could mean that you could die or become paralyzed. Paralysis means you will not ever again be able to move the part of you that is paralyzed. The purpose of this WARNING is to bring your attention to the existence of potential dangers associated with your participation in this activity. There is, however, always the risk of other types of injuries or the risk of injury or death resulting from other causes not specified here.
The purpose of this WARNING is also to aid you in making an informed decision as to whether you should participate in this activity and, as a condition of such participation, sign the following: ACKNOWLEDGEMENT OF HAZARDS AND RISKS CONNECTED WITH SUCH PARTICIPATION. In addition, its purpose is to make you aware that it is your responsibility to be very alert as to matters of your personal safety and to require you to learn as much as possible from and ask questions of [faculty, coaches, physicians, and/or other knowledgeable persons] that you might have at any time regarding your safety and well-being and the safety of the activity. You must inform those faculty/instructors/facilitators who are in charge of this activity of any personal relevant existing medical condition you may have, [and obtain the permission of your personal physician before you can undertake this activity (only if the activity involved any strenuous activity such as having to walk long distances, hike, climb rocks, etc.).] It is your responsibility to dress appropriately for participation in the activity. You represent and warrant that you are physically fit and able to participate in this activity. It is also your responsibility to use all safety equipment and gear provided by or recommended by the instructor/facilitator and follows all instructions given to you before, during, and after the activity.
- 2 -
ACKNOWLEDGEMENT OF HAZARDS AND RISKS
I, ______(Name) want to participate in
______at Edmonds Community College.
I have read the attached WARNING, and I understand that ______
is an activity involving the POSSIBLE RISKS OF INJURY, PARALYSIS, OR DEATH. I also understand that by participating in such an activity/class/program at Edmonds Community College, I am subject to the possibility of injury, paralysis, or death as outlined in the WARNING attached.
By signing this Acknowledgement of Hazards and Risks, I acknowledge that:
- I have read and understand its contents and agree to its terms.
- I have had a chance to ask questions and seek advice.
- I have informed the [faculty/instructor/facilitator] in charge of this activity of all of my existing relevant physical and emotional conditions.
- I am age 18 or over, or if not, that my parent(s) hereby make these promises on my behalf.
- I voluntarily choose to participate in the activity/class/program listed above at Edmonds Community College.
NAME______
Please Print Legibly
______
Signature (If under 18 years of age, signature of custodial parent)
______
Date
Witness/College Official: ______
Signature
______College Position/Title
______Date