Student Agreement Form for National and International Travel

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College of Saint Mary Release of All Claims For and in consideration of being allowed to participate in the (specify activity) by the College of Saint Mary, I release College of Saint Mary, its faculty and staff, and its administration from all claims, demands, damages, actions, and causes of action on account of damage to property, bodily injuries, or death resulting or to result from (specify activity) occurring on (date, time location) by reason of (describe risks involved). The undersigned student further authorizes CSM and its agents to provide emergency medical care should it be necessary. It is understood and agreed by the parties to this release that this instrument is a full and final release of all claims of every nature and kind whatsoever, and that this instrument releases claims that are known and unknown, suspected and unsuspected as a result of the activity described above. I further state that I have carefully read the foregoing release and know its contents and sign the same as my own free act. _________________________________________ ____________________ Signature of Student Date _________________________________________ ____________________ Signature of Parent/Guardian Date (if student is under age 19) _________________________________________ ____________________ Signature of College Official Date
College of Saint Mary Emergency Contact Information Form EMERGENCY CONTACT INFORMATION FOR: Name: ______________________________________________________ Address: ______________________________________________________ City: _______________ State: ___________ Zip Code: _________ Phone Number: _________________________________ In the event of an emergency during the Travel Seminar, please attempt to contact these persons in the order listed: Name: ________________________________________________________ Address: ______________________________________________________ City: _____________________ State: ___________ Zip Code: _________ Phone Number: _________________________________ Relationship: ___________________________________ Name: ________________________________________________________ Address: ______________________________________________________ City: _____________________ State: ___________ Zip Code: _________ Phone Number: _________________________________ Relationship: ___________________________________ Name: ________________________________________________________ Address: ______________________________________________________ City: ________________ State: ___________ Zip Code: _________ Phone Number: _________________________________ Relationship: ___________________________________
Page 1 and 2: Explanatory Notes about the Student
Page 3: 2) I do not possess health insuranc

Student Agreement Form for National and International Travel

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