EXAMPLE: LONG FORM PARTICIPATION AGREEMENT AND
ACKNOWLEDGEMENT OF RISKS
In consideration of my being permitted to participate in the Trip, Event, or Activity (TEA):
(description) ________________________________________to take place on (date)
_____________ 20(xx)
I agree and understand that

I will attend all required meetings and orientations;

I will complete all necessary forms and paperwork and pay any necessary deposits
or fees on time;

I will be personally and completely liable for any expenses, including but not
limited, to medical or health care expenses for medical treatment, illness, or
condition, incurred for or on my behalf;

The University does not provide medical or health insurance coverage for me, nor
automobile liability or damage insurance for my personal automobile;

I will confirm that I have individual coverage for my personal medical and health
insurance coverage while participating in the TEA;

I will abide by all the rules, regulations, and specifically the Student Code of
Conduct of the University of South Carolina and any other required policies,
rules, requirements, including those of the Host/Site location of the TEA. If I do
not, I may lose privileges and payments;

I may be asked to leave the TEA if I do not abide by the rules, regulations, and
codes of conduct of the University of South Carolina and/or the Host/Site location
requirements and may be required to return to my permanent or university
residence at my own expense;

I may be disciplined for any failure to abide by the rules, regulations, or laws that
apply, which may include student judicial disciplinary procedures with sanctions
leading up to permanent expulsion from the University and any academic programs in
which I am enrolled, as well as loss of any deposits or fees that I have paid in
connection with the TEA and/or may be required to reimburse the University for
costs incurred on my behalf;

I will advise the University representative and/or Host/Site administrators of any
situation or condition that may be potential a hazard or risk to myself or others;

I UNDERSTAND THAT THERE ARE RISKS INHERENT IN THE TEA
IN WHICH I WILL BE PARTICIPATING. I ACKNOWLEDGE AND
ASSUME THESE RISKS AND ACCEPT THAT MY PARTICIPATION
MAY RESULT IN LOSSES, PERSONAL INJURY, EVEN DEATH,
ILLNESS, LOSS OF LIMB, OR EVEN DEATH, HEALTH CONDITIONS,
DISEASES, INCLUDING DAMAGE OR LOSS OF MY PERSONAL
PROPERTY.

I certify that I am 18 years of age or older.
_________________________________
Signature of Participant
Date:
_________________
Print Name: _______________________
A Parent or Legal Guardian must sign if Participant is under the age of 18:
I warrant I am a Parent or Authorized Legal Guardian of the participant
____________________________________
Parent/Legal Guardian
Date: ___________________
Witness: ________________________________
Date:_____________________