JASS BEACH TRIP 2022
Friday, MAY 27th – Monday, MAY 30th
EMERGENCY MEDICAL RELEASE FORM
I understand this is an event sponsored by the Japanese American Student Society
at the University of California, Davis and I agree to participate and act in
accordance with the rules and regulations set by the organization. I have chosen to
voluntarily participate in this activity, and I am responsible for all risks and
responsibilities pertaining to my physical condition and for any injuries or damages
to myself, or personal property that I might sustain over the duration of the trip.
Therefore, I understand that the hosting organization is not responsible in any way
for my person and my belongings. In the case that I require medical attention
beyond first aid treatment, the person(s) in charge has my permission to obtain
emergency medical treatment on my behalf.
COVID-19 TESTING REQUIREMENT
Due to COVID-19, I agree to get COVID tested on Wednesday, May 25 and present
results to a cabinet member. I also agree to get tested within the week following
return.
With my signatures below, I acknowledge that I have read this waiver in its entirety,
and fully understand its terms, conditions, and meanings.
_______________________
Name
_______________________
Phone Number
Davis Address (Street, City, State, Zip Code)
_______________________
Health Insurance Company
_______________________
Policy Number
For Emergencies:
_______________________
Person to Contact
_______________________
Contact Phone Number
_______________________
Signature
_______________________
Date