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I hereby certify that I am over the age of eighteen and by my signature below, I hereby release John Carroll University (JCU), its officers, agents, employees, successors, and assigns from any and all liability, not caused directly by negligence of JCU or its representatives, arising out of or in any way related to my participation in a student field trip to participate in the Ohio Valley Model Arab League at Shawnee State University: 2nd St, Portsmouth, OH 45662. The group will be staying at the Holiday Inn : 711 2nd St, Portsmouth, OH 45662. The group will leave on Thursday February 20, 2020 and return on Saturday, February 22, 2020. I understand that this is a voluntary trip/activity and as with any such trip/activity there will be risks involved with these activities. I hereby accept these risks. Transportation I understand that the University is providing transportation by a the University bus. . I accept this responsibility and associated risks with this trip. Overnight Accommodations I understand that the University is providing overnight accommodations and that any damages or charges as a result of my actions that are deemed to be outside of the scope of this trip will be my responsibility. I accept this responsibility and associated costs. I further understand that if I elect to stay on past the end of the program (Saturday February 22, 2020), I will do that at my own risk and responsibility. Faculty/Staff Supervision I understand that there will be no University faculty and/or staff accompanying me on this trip and that I must comply with University policies concerning alcohol and drug use, vehicle use, student misconduct, smoking, principles of academic freedom, policy on sexual harassment, etc., just as I would on campus. I accept this responsibility. If I require medical care while participating in the activities of this trip, I authorize JCU through its employees or agents to contact the person listed below, or if that is not possible, I authorize JCU through its employees or agents to summon emergency medical care or to take me to the nearest medical facility for purposes of receiving medical care with the understanding that I will not hold JCU, or its employees, agents or representatives responsible for the actions of the agents, representatives or employees of the medical facility and that I will assume any and all responsibility for payment of same.
First Emergency Contact Address
Second Emergency Contact Address