By my signature below, I choose to participate in this Activity/Program. In
consideration for being permitted to participate in the Activity/Program, I hereby represent and agree as follows:
- I understand that participation in the Activity/Program involves risks not encountered during routine college study, including risks involved in traveling to, within, and returning from, the site(s).
- ASSUMPTION OF THE RISK I understand the risks involved in participating in the Activity/Program, and I hereby assume all risks and responsibilities for my own health and safety, whether or not stated in this Waiver. I have no known or suspected medical reasons, risks, or problems that preclude or restrict my participation in the Activity/Program, or make my participation in the Activity/Program ill-advised from the standpoint of my personal health and
safety given the risks involved.
- I hereby waive, release, and hold harmless Mid Michigan College, its Board, administration, faculty, support staff, sponsors, supervisors, employees, and representatives, from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participating in the Activity/Program whether such liability, claims,
or demands results from travel. I understand and acknowledge that this Release discharges Mid from any liability or claim against it with respect to any bodily injury, personal injury, illness, death, monetary loss, or property damage that may result from my participation in the Activity/Program. I understand that Mid assumes no responsibility for or obligation to provide
financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, accident, monetary loss, or property damage. I further agree to indemnify Mid, its Board, administration, faculty, support staff, sponsors, supervisors, employees, and representatives from any actions brought against it as a result of my
acts, negligence, or omissions.
- I understand that Mid does not represent or function as an Agent for any host institution, hotel, food, tour services, transportation companies, or any other goods or services connected with this Activity/Program. I further recognize that Mid: a) is not responsible or liable for any injury, damage, loss, accident, delay, or other irregularity created by any company or person engaged in providing or performing services involved in the Activity/Program b) is not responsible for any irregularity which may be caused by a vehicle defect or the negligence or default of any company or person engaged in providing or performing any of the services involved in this Activity/Program; c) is not responsible for losses or expenses, including but not limited repatriation expenses, due to sickness, weather, strikes, hostilities, natural disasters, acts of terrorism, or the personal decision to leave the Activity/Program early or any other related causes; and c) is not responsible for any disruption of travel arrangements or any consequential additional expenses that may be incurred therefrom.
- I acknowledge and agree to accept all responsibility for, and acknowledge that Mid is not responsible for any loss, damage, destruction, or theft of my personal belongings; and that I have adequate funds to replace such belongings. I release and will hold Mid harmless therefrom.
- I recognize and am in agreement that in the event that I would become detached from the group, fail to meet a departure bus, airplane, train, or other conveyance; become sick or injured and unable to travel, or choose to travel to the site of the Activity/Program early, or remain after the Activity/Program has concluded, I will bear all responsibility for all associated expenses.
- I understand that should I choose alternate transportation to and/or from the Activity/Program than the College is providing, I must complete the Mid Transportation Waiver before utilizing said alternate transportation.
- I may not purchase, possess, and/or use any illegal or unauthorized drugs during the duration of the program, including free time. I understand that illegal drug purchase, possession, or use jeopardizes me, other students, and the Activity/Program itself. I understand that violation of this rule of conduct may result in immediate expulsion from the Activity/Program. I further understand that I would be responsible for the costs of transportation home.
- I assume responsibility for my actions, understanding that the circumstances of the Activity/Program likely require a standard of behavior that may differ from that which is applicable on campus. If I encounter legal problems while participating in this Activity/Program, I will attend to the matter personally at my own expense and will hold Mid harmless therefrom. I further understand that Mid is not responsible or under obligation to provide any assistance under
such circumstances, and that Mid cannot obtain release from jail if I am jailed for any reason.
- I will comply with all of Mid’s standards, guidelines, and instructions for student conduct and behavior including those published in the Student Code of Conduct; Campus Non-Discrimination, Harassment, and Sexual Misconduct Policy; Title IX Sexual Harassment Policy; Alcohol and Other Drug Policy, and those of this Activity/Program (collectively, “standards”). I acknowledge and understand that my compliance and submission to the guidelines is important to the success of the Activity/Program and will influence Mid’s willingness to permit future similar activities. I agree that in its sole judgement, Mid has the right to enforce the standards and it may impose
restrictions, up to and including disciplinary proceedings and removal from the Activity/Program for violating the standards or for any behavior that is disruptive, detrimental, or incompatible with the interest, harmony, and welfare of the Activity/Program or its participants. I also agree to adhere with all directions and instructions of the Program Director and Chaperones during the course of the Activity/Program and that failure to do so may result in the imposition of restrictions.
- I agree that due to the circumstances of out of State travel, any procedures for Hearings, Appeals, or Notices applicable to Mid’s judicial process may apply at the discretion of the Program Director. If I am removed from the Activity/Program, I consent to going home at my own expense without a refund from the College for any monies I may have paid to participate in the
- I understand that it is within Mid’s discretion to change accommodations, travel, or other arrangements as it deems necessary. I understand that the College is not responsible for, nor does it represent or act as an agent for, and thus cannot control the acts or omissions of any host institution or service providers. This includes those who provide transportation, tours, dining, or
sleeping accommodations. I understand that Mid may cancel this Activity/Program; withdraw any part of the Activity/Program, and make alterations, deletions, or modifications in the itinerary as deemed necessary by the College or Director of the Program.
- I agree to: a) consult with a medical doctor with regard to my personal medical needs and confirm that there are no health-related reasons or problems which preclude or restrict my participation in this Activity/Program b) arrange for adequate medical and hospitalization insurance to meet any and all needs for payment of medical and hospital expenses while engaged
in the Activity/Program c) assume all risk and responsibility, therefore d) consult and arrange with a medical doctor to receive the appropriate inoculations/shots for this trip (vaccination information can be found by visiting the Center for Disease Control and Prevention at https://wwwnc.cdc.gov/travel/destinations/list) if applicable e) pay for any and all medical and hospitalization expenses incurred and f) release Mid from any legal responsibility for payment of my medical, medication, or hospitalization requirements and from any other claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered to me or to my dependents/companions in connection with an emergency or health problem during my participation in the Activity/Program.
- In the event of illness or injury, I hereby authorize the Program Director or assigned Chaperone to obtain emergency or medical treatment on my behalf in the event of a health emergency to secure medical treatment on my behalf in the event of a health emergency, and I accept financial responsibility for such medical treatment. I also authorize them to arrange to transport me back to
Michigan for medical treatment. I agree that I am fully responsible for any and all expenses, including transportation costs, associated with or in any way related to my medical care. I also authorize the college or its agents to release medical information obtained from me to a care provider or others in the event of a health emergency or as needed to provide reasonable accommodations. I hereby release and forever discharge Mid from any claim whatsoever which
arises or may hereafter arise on account of any first-aid treatment or other medical services rendered to me in connection with an emergency or health problem during my participation in the Activity/Program.
- I understand that I am responsible for the safety of my personal possessions, documents, money, travel tickets (as applicable), and any other property. I assume full financial responsibility for all costs and expenses incurred by me in connection with the Activity/Program. This includes without limitation, the financial responsibility for lost or damaged property from any cause whatsoever, and for any damage or destruction to the property of third parties of which I am at fault.
- I will not hold myself out as possessing the power or authority to bind or create liability for Mid.
- I represent that my statements herein are accurate and complete and that my agreement to the provisions herein is voluntary. I further understand that prior to signing this Agreement, I have the right to consult with an adviser, counselor, or attorney of my choice.
- I agree that should any provision or aspect of this Student Activity/Program Participation Agreement, Release, and Waiver of Liability be found to be unenforceable, that all remaining provisions will remain in full force and effect.
- I understand and agree to abide by the Additional Terms and Conditions of the Participation Agreement.
This form is being submitted to the Program Director. Note any additional information which should be disclosed to the Program Director below. This may include any physical or mental conditions that might restrict your safe participation in this Activity/Program or any special medical conditions that might require emergency assistance. If you require any reasonable accommodation in order to participate, you must register with Mid's Student Accommodation Services before departure. If a reasonable accommodation is requested, Mid will review the reasonableness of the requested accommodation, taking into consideration the requirements of the Activity/Program, the supporting documentation, and the availability of resources.