Voluntary Excursion Notice
Field Trip/Excursion: _____________________________________________________
I understand that pursuant to the California Code of Regulations, Subchapter 5, Section 55450,
by participating in the field trip(s)/excursion(s), I am deemed by law to have waived any claims
against Mt. San Jacinto Community College District for injury, accident, illness or death
occurring during or by reason of the field trip/excursion.
I have no known medical condition(s) which may pose a risk to the health and safety of me or
others by participating in the activity (ies). I agree to advise the District in writing of any
medical, physical or health condition which may be affected or in any way jeopardized by
participating in a specific field trip/excursion.
In the event of accident or illness please notify:
I hereby acknowledge and understand that unless specifically advised otherwise, the college is
not providing the transportation and it is my responsibility to arrange for my transportation to
and from the activity. If the college is providing transportation but I do not use the
transportation, I am responsible to make my own arrangements and the college assumes no
responsibility or liability of any kind.
If the college is not providing the transportation I further understand:
• the driver of the vehicle in which I am riding, either as driver or passenger, is not driving on
behalf or as an agent of the college, and the college has not verified the driving record of
the driver, the liability insurance on the vehicle, or the condition of the vehicle;
• the college is in no way responsible, nor does the college assume liability, for any injury or
loss which may result from my transportation;
• although the college may assist in coordinating the transportation and/or recommend
travel time, routes, car pooling, or caravanning, recommendation(s) or travel assistance
provided is not mandatory;
Name (Print) ________________________________________
Signature _____________________________________Date ____________________
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