Mid-Atlantic Bus Trip and College Tour (April 2025)

Mid-Atlantic Bus Trip and College Tour

Hampton University, Norfolk State University, Elizabeth City State University, Virginia Union University
Trip Information
The Tri County HBCU Alliance is sponsoring a trip to tour Virginia Union University, Elizabeth City State University, Hampton University, and Norfolk State University. Please complete the permission slip and submit depost by Friday, March 28, 2025.

Date: April 23 - 24, 2025

Locations: Virginia Union, Hampton, Norfolk State, and Elizabeth City State Universities

Purpose: Provide college tours

Eligibility: High School Students interested in attending an HBCU

Cost: $250 per attendee ($50 non-refundable deposit, final payment of $200 due by April 11, 2025)

Transportation: Chartered Motorcoach

Depart: Wednesday, April 23, 2025: Rock Hill, SC: 4:00 AM

Return: Thursday, April 24, 2025: Rock Hill, SC: 11:00 PM
Teen Code of Ethics
Parent/Guardian: I have read the Teen Code of Ethics, and I understand the contents apply to all Tri County HBCU Alliance events, including college tours. I have discussed the behavior expectations with my Teen. Furthermore, I understand the consequences of non-compliance for teens and agree to accept the disciplinary action(s) rendered by Tri County HBCU Alliance officers/chaperones.
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Student Information
Student's First Name*
Student's Last Name*
Student's Gender*
Student's Age*
Student's High School of Attendance*
Student's Grade*
Student's Email Address*
example@example.com
Student's Phone Number*
Please enter a valid phone number.
Insurance Carrier
Policy Holder
Insurance Phone Number
Policy/Group Number
Primary Physician Name
Primary Physician Phone Number
Parent/Guardian Information
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact First & Last Name*
Emergency Contact Relationship to the Student*
Emergency Contact Phone Number*
Please enter a valid phone number.
Medical Information
Please list any important medical information trip chaperones should know. Also, include any allergies or food restrictions as well.*
Tour Disclosure and Authorization Signature
TOUR DISCLOSURE: Tri County HBCU Alliance college tour (hereinafter TOUR) will do its best to provide a safe environment while conducting all TOUR activities. However, it's important to understand that there may be certain unforeseen risks that occur while your child attends or participates in the TOUR. Therefore, your signature below releases Tri County HBCU Alliance and TOUR staff from responsibility as follows: I understand that the TOUR assumes no responsibility for any personal injury, loss, or damage to property that my child may suffer while participating in the TOUR, including exposure to the COVID virus, while being transported to, from or in connection with the TOUR, or at any other time during his/her entire participation in the TOUR. In full recognition and appreciation of the potential risks inherent in participation in the TOUR, I release, unload forever, and agree to keep harmless, Tri County HBCU Alliance (including its executives, administrators, trustees, employees, representatives, volunteers, and agents), TOUR staff, the State of South Carolina, your representatives, agents, successors and assigns to and against any and all claims, claims, actions or causes of action, known or unknown, that my child or I may have, arising out of or in connection with any injury, accident, illness, death and/or any loss or damage to personal property that occurs during my child's stay on the TOUR, or as a result of my child's participation in or transportation to/from the TOUR. This release is intended to unite my heirs (as well as those of my child), agents, representatives, successors, and assigns. It is understood that your signature grants permission for your child to participate in activities associated with the TOUR and any associated follow-up activities.
I give permission for my child (listed on the form) to participate in the college tour from April 23, 2025, to April 24, 2025. I also give permission for my child (listed on the form) to receive medical treatment.
I agree with the above Tri County HBCU Alliance college tour disclaimer.
I have read this responsibility, understand its content and sign it freely and voluntarily. I understand that my child will not be allowed to participate in the tour without my signing of this waiver.
By signing this waiver, I confirm that I have voluntarily decided to allow my child to participate in the college tour. In addition, it attests that all information in this application is correct.
I am aware that photographs and/or videos may be taken during the experience for the purpose of publicizing, promoting, and illustrating the Tri County HBCU Alliance’s programs. I agree to allow staff and their representatives to take and use these images and likenesses for those stated purposes. I hereby release and discharge Tri County HBCU Alliance and its representatives from any and all claims and demands arising out of or in connection with the use of the photographs, slides, and/or video images of my child, including without limitation any and all claims for libel or invasion of privacy.
Parent/Guardian Signature*

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Tri County HBCU Alliance College Tour*

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For additional information, https://www.tricountyhbcu.org/

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Mid-Atlantic Bus Trip and College Tour

Trip Information

Teen Code of Ethics

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Tour Disclosure and Authorization Signature

For additional information, https://www.tricountyhbcu.org/