OTC Assumption of Risk, Code of Conduct, Release of Liability, Limited Medical Authorization, and Conditions of Participation Form Exhibit

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Ogeechee Technical College
Assumption of Risk, Code of Conduct, Release of Liability, Limited
Medical Authorization, and Conditions of Participation
Student Name:
Date of Field Trip: Click here to enter text.
Time of Field Trip: Click here to enter text.
Location of Field Trip: Click here to enter text.
Code of Conduct
I hereby agree that in consideration of my being permitted to participate in this Ogeechee Technical
College field trip as a student, I will be subject to the supervision and authority of the faculty member
and/or Ogeechee Technical College employee in charge. I also understand and agree that the faculty
member and/or Ogeechee Technical College employee in charge has the sole authority to make
decisions regarding my continued participation in the field trip if it is determined that my conduct warrants
disciplinary action or that my continued participation, for whatever reason, poses an immediate risk of
harm to me or to others.
Assumption of Risk, Waiver of Liability, and Medical Authorization
I recognize that participation in the field trip entails certain risks to my property and person which, in rare
circumstances, can be serious or even lethal.
I freely assume those risks associated with these activities. I further understand and agree that Ogeechee
Technical College shall not assume any liability for damage to or loss of my property or for financial
obligations incurred by me. I also agree to give up any rights I may otherwise have to sue or otherwise
bring claims against Ogeechee Technical College and its officers, faculty, employees or agents, for
personal injuries or death or other harm, except for those injuries, death or other harm caused by a
deliberate wrongful act of the aforementioned Technical College and/or of its officers, faculty members,
employees or agents. I understand that it is possible for me to purchase insurance, at my own expense,
that will indemnify me against the risk of the financial losses outlined in this paragraph.
Limited Medical Authorization
In the event of an emergency and I am unable to act on my own behalf, I authorize the faculty
member/staff member sponsoring the field trip to take whatever action deemed necessary and
appropriate regarding my health and safety.
Conditions of Participation
Field trips away from campus are allowed as a means of enhancing the student learning experience.
Participation in field trip activities is a privilege. All students who wish to participate in Ogeechee
Technical College field trips are required to carefully review and sign the following statement which
constitutes conditions for participation.
1. I understand that as a field trip participant I am a public representative of Ogeechee Technical
College and that my actions and conduct affect others.
2. I understand that I am accountable for my actions and that I am expected to make responsible,
lawful decisions. As such, I understand that I am subject to federal, state, and local laws and
agree to abide by those laws throughout the trip. I understand that Ogeechee Technical College
will be limited in its ability to provide assistance in the event of arrest and may also institute
disciplinary proceedings.
3. I understand that as a participant on an Ogeechee Technical College field trip that I am subject to
all of the student conduct regulations described in the College’s Catalog and Student Handbook.
Adopted April 18, 2007; Revised April 15, 2009; Revised August 19, 2010; Revised March 29, 2011;
Revised March 27, 2012; Revised April 17, 2013; Revised April 16, 2014; Reviewed September 16, 2015
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4. I agree that the faculty member and/or Ogeechee Technical College employee in charge may
terminate my participation in the trip if I engage in actions that endanger myself or others or if my
conduct is considered to be detrimental or incompatible with the best interest and welfare of the
program. I further agree, if expelled from the trip, to be responsible for all expenses incurred in
returning to Ogeechee Technical College.
5. I agree not to be in possession of or consume any illegal substance.
6. I agree to participate fully in all planned activities.
7. If lodging is involved, I agree not to disturb hotel or restaurant guests in any way.
8. If I am currently taking prescribed medications, l agree to do so in a timely manner and according
to the prescription.
9. I agree to be responsible for any and all health care costs incurred by me on the field trip.
10. I am aware of the nature and cost of the field trip activity and will guarantee that all preset
financial obligations will be met.
11. I understand that Ogeechee Technical College reserves the right to cancel field trips in the case
of insufficient participation or for other reasons deemed appropriate. The College also reserves
the right to make changes to the field trip (such as field trip leader) or alterations in the field trip's
proposed schedule and itinerary. I further understand that should the field trip--or any portion of
the field trip--be canceled, Ogeechee Technical College shall have no responsibility beyond the
refund of all deposits made and monies paid to Ogeechee Technical College by participants.
Minor alterations in field trips will not result in refunds.
12. I understand that field trips are well planned in advance and the costs are usually divided among
participants. The costs of each trip vary and payment may be required in advance. Occasionally,
Ogeechee Technical College may pay all or a portion of the costs of the trip. If a student commits
to a trip and fails to attend, the student will be held financially responsible for reimbursement to
Ogeechee Technical College for the amount paid that cannot be refunded by the vendor prior to
departure or are part of the general expenses to be equally divided by the total number of
participants. The latter may include, but are not limited to, costs of transportation and group
lodging contracts. A hold will be placed on the student's records until the amount is paid. The
specifics of each trip will be explained by the field trip leader.
13. I understand that I am responsible for any and all damage to or loss of property and for any
financial obligations incurred by me including but not limited to damage to property, telephone
calls, movie rentals, etc.
Signature of Student _____________________________ Date ___________
Printed Name of Student _________________________________________
Emergency Point of Contact Name:_________________________________
Emergency Point of Contact Phone Number(s):________________________
Adopted April 18, 2007; Revised April 15, 2009; Revised August 19, 2010; Revised March 29, 2011;
Revised March 27, 2012; Revised April 17, 2013; Revised April 16, 2014; Reviewed September 16, 2015
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DECLARATION AND RELEASE OF PARENT OR GUARDIAN FOR
PARTICIPANTS WHO ARE UNDER 18 YEARS OF AGE
Student Name:
Date of Field Trip: Click here to enter text.
Time of Field Trip: Click here to enter text.
Location of Field Trip: Click here to enter text.
I certify that I am the parent or legal guardian of the above named student. I have read the forgoing
Assumption of Risk, Code of Conduct, Release of Liability, Limited Medical Authorization, and Conditions
of Participation form, and I understand it. I accept and agree to be bound by, on my own behalf and on
behalf of the above named student, the terms and conditions set forth in the forgoing Assumption of Risk,
Code of Conduct, Release of Liability, Limited Medical Authorization, and Conditions of Participation form.
Parent/Legal Guardian Signature ______________________________ Date ___________
Parent/Legal Guardian Printed Name ___________________________________________
Adopted April 18, 2007; Revised April 15, 2009; Revised August 19, 2010; Revised March 29, 2011;
Revised March 27, 2012; Revised April 17, 2013; Revised April 16, 2014; Reviewed September 16, 2015
BLT
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