WHEREAS, I wish to participate in the field trip described
below:
_________________________________________________________ __________
(Short
description of field trip)
(date)
as part of the course entitled
"_____________________________________________.”
WHEREAS, I understand this to be part of my course work at
the
I will not possess or use illicit drugs or alcohol while
participating in class work. Lawful
use of alcohol is permitted only during my free time.
I will follow
the student code of conduct as described in The Cat’s Tale.
I assume full
responsibility for any personal activities in which I participate that are
outside the scope of required course work. I understand that the
University does not provide coverage for the use of my personal vehicle.
To the best of my knowledge, I am in good health and suffer
no disability or condition which renders my participation in trip activities
medically inadvisable.
I consent to the administration of emergency first aid and
authorize UVM personnel to obtain emergency medical care on my behalf should it
be necessary. I understand I will
be responsible for expense associated with such care.
By signing below, I acknowledge that I have read, understand
and agree to abide by this agreement.
________________________________________________
_______________
Signature of Participant
Date
___________________________________________________
Name (please print)
_________________________________________________
_______________
Signature of parent or guardian
Date
(if participant is under 18 years of
age)