Student Agreement Form for National and International Travel

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College of Saint Mary Student Agreement Form for National and International Travel This Agreement is signed and given by the undersigned to the appropriate Vice President at College of Saint Mary in consideration for the opportunity to participate in CSM-sponsored travel that involves at least one overnight stay. Participation in this trip is considered to be both an honor and a responsibility. I understand that I am representing College of Saint Mary and my behavior during this experience is a direct reflection upon the College. I will attend and actively contribute to all parts of this experience, including participating in all pre-trip and post-trip meetings. I will act responsibly and professionally during scheduled and free time. I understand that the College of Saint Mary Student Handbook and Code of Conduct are in full effect during the entire trip. I will obey all state and U.S laws, laws of the countries I am visiting, as well as College policies and regulations. If I am under the age of 21, I agree that I will not consume alcohol. If 21 or older, I will not provide alcohol to minors. If I am 21 or older and choose to consume alcohol, I will do so only under circumstances congruent with the educational purposes of the trip as determined by the Facilitator(s) prior to the trip. I will be subject to College discipline if my behavior generates disorder, creates disturbance, damages property, or presents a danger to myself or others. I understand that the Facilitator(s) have the authority to send me home at my own expense for violating this agreement, state laws, or the laws of the United States. I respect the authority and responsibility of the Facilitator(s) and will abide by their decisions. National and International Travel sponsored by College of Saint Mary ends on the last scheduled day of the trip—upon return to the final destination stated in the itinerary. I will return with my group unless prior arrangements have been made and approved by the College. College of Saint Mary is not responsible for any student electing to remain at a site, or travel to another destination after the trip. Safety is a primary concern. I will promote a safe environment and understand that some aspects of the trip may be changed or canceled to address safety. In order to promote communication among group members, I agree to limit cell phone, computer, and other electronics use to emergencies and to free time. I will turn my cell phone off during presentations and other scheduled time. Health Insurance Section: (please complete either option 1 or 2) 1) I possess health insurance. My policy is through _________________________________________ (name of insurance company) and my policy number is _________________________________. I understand that I am responsible for meeting the deductible on my insurance. OR
2) I do not possess health insurance, and I understand I am responsible for any health care costs I incur during this trip. For all students traveling on international trips only: If international travel insurance for health care is not included in my health insurance policy, or if I do not possess health insurance, I will purchase special international health insurance coverage for the period I plan to travel outside the United States. I understand that my $__________deposit for the trip is nonrefundable, even if I am unable to go on the trip as planned. I understand that I owe $ ______________ towards the cost of the trip, which I will pay in full by __________________. The Facilitator(s) of this trip may add additional expectations here: By signing below I register my agreement with the statements listed on this document. Printed Name (Student) Signature (Student) Date Printed Name of Parent/Guardian (if the student is a dependent) Signature of Parent/Guardian (if the student is a dependent) Date
Page 1: Explanatory Notes about the Student
Page 5: College of Saint Mary Emergency Con

Student Agreement Form for National and International Travel

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