Field Trip Waiver Form
This form must be completed and submitted to the respective departmental office prior to departure. No student or visitor may
participate in the event unless his/her signature appears on this form.
Organization: _________________________________________________________________________________________
Activity: _____________________________________________________________________________________________
Date: ______________ Time: _____________________ Trip Coordinator: ______________________________________
Contact Information: ____________________________________________________________________________________
I hereby understand that I hold Reading Area Community College (the sponsor), its officers, employees and agents harmless from all
liability and claims arising out of or in connection with my participation in this activity. I understand that participation in the above
activity is voluntary and is not required.
In the event of an accident or sudden illness, the sponsor has my permission to render whatever emergency medical treatment may be
deemed necessary for my safety and welfare. I agree that any expenses incurred in connection with such treatment shall be my
responsibility.
I agree that in connection with this activity the possession or use of alcoholic beverages, illegal drugs and/or chemicals is strictly
forbidden and a violation of the RACC Student Code of Conduct for which I will be prosecuted to the fullest extent of the Code.
I agree that I will abide by all rules and regulations of RACC and will comply with instructions given by the College representatives.
Name of participant: ______________________________________ Student ID: _________________ Phone: ___________________
Signature of participant: _______________________________________________________________ Date: ___________________
Name of emergency contact: ________________________________ Relationship: _________________ Phone: _________________
