WHEREAS, I wish to participate in the field trip described below:


_________________________________________________________   __________

 (Short description of field trip)                                                                                  (date)


as part of the course entitled "_____________________________________________.Ē


WHEREAS, I understand this to be part of my course work at the University of Vermont, I therefore agree to abide by the following:


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 Catís 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)