Fillable Inter-Club Council Fieldtrip Check List All additional forms (Mt. San Jacinto Community College District)

Fill Online, Printable, Fillable, Blank Inter-Club Council Fieldtrip Check List All additional forms (Mt. San Jacinto Community College District) Form

Use Fill to complete blank online MT. SAN JACINTO COMMUNITY COLLEGE DISTRICT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Inter-Club Council Fieldtrip Check List All additional forms (Mt. San Jacinto Community College District)

On average this form takes 29 minutes to complete

The Inter-Club Council Fieldtrip Check List All additional forms (Mt. San Jacinto Community College District) form is 5 pages long and contains:

  • 3 signatures
  • 25 check-boxes
  • 94 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Mt. San Jacinto Community College District

BROWSE MT. SAN JACINTO COMMUNITY COLLEGE DISTRICT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Inter-Club Council Fieldtrip Check List
All additional forms listed that are required for your fieldtrip must
be submitted with your event form to the ICC Vice President or the
ICC Advisor. Failure to complete all necessary forms will delay
your fieldtrip planning process.
Club Approval-In meeting at least 4-6 weeks before fundraiser
date
Minutes reflecting club approval
Fieldtrip request form
Voluntary Excursion Notice
Voluntary Activity Form
Personal Vehicle Use Form (if students are driving themselves
and one another)
Emergency Information Form
Vehicle Request Form
Approval from the Foundation if money is being accepted
or raised with an outside business
Email to ICC advisor from club advisor confirming they will be
present for the fieldtrip
*if necessary, please see event form for qualifications
Mt. San Jacinto College
Activity/Fund Raiser Application
Please use blue/black ink and print clearly.
Club Name
President’s Name
Phone # & E-mail
Member Responsible for Event
Phone # & E-mail
Advisor’s Name
Important--Please Read!
Phone # & E-mail
ICC Representative’s Name
Phone # & E-mail
* This application must be submitted to the Inter-Club Council at least one meeting before the date of the event by
your ICC Representative. The activity cannot be the same week the form is turned in. In other words, if you are
submitting an Activity Application on Tuesday, your event cannot be held Wednesday-Sunday of that same week.
* The ICC will not recognize any application for an event unless the club has had its charter approved by ICC for the
current semester. STOP!! If your club charter is not current, you must have your charter approved before an
Activity/Fund Raiser Application can be submitted.
Activity Information: Complete this section and obtain appropriate signatures. Signatures 1, 2 and 3 on back of form are always
required. A Student Life Staff Support Person will circle the additional signatures required for your event.
Date of Activity:
Time:
am pm to
am pm
Description: Guest Speaker Information/Display Table Cultural/Music Celebration
Service Project (Describe) Other (Describe)
Location: On Campus-Building/Room Off Campus-Address
Non Students: If your activity/program involves attendance/participation/presentation by non-students (guest speaker, band, DJ), list
names, addresses and phone numbers for each individual. Attach an additional sheet if necessary.
Name Address Phone #
Parking for guests/speakers must be arranged. Without prior approval, guests are subject to ticketing for parking in permit parking lots
without a permit. Permits can be arranged through MSJC Campus Safety Office at least two weeks in advance.
Fund Raiser Information Complete this section and obtain appropriate signatures. Signatures 1, 2 and 3 on back of form are always
required. ICC Advisor(s) will circle the additional signatures required for your event. Each club must clean up after their event.
Date of Fund Raiser:
Time:
am pm to
am pm
Location: On Campus-Building/Room Off Campus-Address
Type of Fund Raiser: Food Sales:
List food to be sold. Attach an additional sheet if necessary. Sale price of each item.
Club/Organization not using the MSJC cafe for food sales must have permission of Ron or Mandie
before the sale of prepacked items.
Non-Food Sales:
List items to be sold. Attach an additional sheet if necessary. Sale price of each item.
Opportunity Drawing:
Date of Drawing Location of Drawing Ticket Price
Item Awarded with Ticket If award was donated, name of donor.
Other:
click to sign
signature
click to edit
click to sign
signature
click to edit
Submitted to the Student Senate for Approval on:
IMPORTANT NOTE: Your event is NOT considered approved until ALL necessary steps listed below are completed. You MUST
Obtain all the necessary signatures before submitting.
Required Signatures
1.
Club Advisor’s Approval of event/fund raiser. 6. Equipment Needs:
Club Advisor/Date
2.
Club President Approval: of activity/fund raiser.
Chairs
Tables
Club President/Date
3.
Foundation Approval if activity involves collection or
disbursement or collection of monies from outside
businesses.
Associate Dean, Student Affairs & Equity
7. Use of Facilities Form for events taking place
outside, on campus Application is available at
The MSJC Student Life and Development Program Offices.
Form has been submitted to facilities on .
Rebecca Orlauski, Foundation Operations Coordinator /Date
Associate Dean, Student Affairs & Equity
4.
On Campus Location Reservation
College Facility: /
Bldg. /Room
Please CC ICC advisor(s) & club advisor(s) when
requesting rooms from designated peoples/offices.
5.
Café Approval: for use of off campus prepackaged foods
for sales.
Ron Guglielmana, Mandie Hornback or Designee
Which signatures do I need?
1.
Fundraisers - #1, 2 ,3, 4, add #5 if a food fundraiser
2.
On Campus Event held in the Quad #1, 2, 6, 7 add #3 if involves collection or disbursement of money from an outside
business, add #5 if food is not being served by the MSJC cafe
3.
All on campus events require a district facilities use form to be filled out and turned into the office of instruction on the
designated campus no later than a week before your event
.
STOP!
After obtaining all signatures as required above, present this application to your Senate Representative who will submit it for approval.
You will be notified by the ICC if your event is not approved.
Approvals
10a.
10b.
ICC Vice President /Date ICC Advisor /Date
10c.
Associate Dean, Student Affairs & Equity 1/11
APPLICATION NOT APPROVED FOR THE FOLLOWING REASON
Pending Signatures Of
Incomplete Information Lacking Required Signatures Other C o m m e n t s :
Signature/Date
Title
click to sign
signature
click to edit
Volunteer Activity/Excursion Form and Waiver – Updated 050319
P a g e | 2
Type of Field Trip (check one):
Single Day Trips
One day – school Day Overnight Trip (# of nights )
One day – non-school day Out of State Trip (# of nights )
Trip to Foreign Country (# of nights )
Trip Details
Activity/Excursion/Event Title:
Destination Name:
Destination City/State:
Departure Date
Return Date:
Depar
t
ur
e
T
i
m
e
(
a
ppr
ox
.
)
:
AM/PM
Retur
n
T
i
m
e
(
a
ppr
ox
.
)
:
AM/PM
Purpose of trip
(Educational Benefit):
Name of Class/Club:
Employee in Charge: Cell #:
Other Employees on Trip:
Emergency Information
Closest Hospital/Emergency Room:
District Vehicle Student and/or Employee driving their own vehicles
Required Items (check):
I
certify that
I will
provide a Personal Vehicle Use form for
each
employee driving their own vehicle.
I
certify that
I will
provide a
list
of participants and class handout for this trip.
I certify that all student participants have completed the required student form/waiver. All forms will be
kept on file in associated department for one year plus one day after the date of the field trip.
Signatures:
Faculty Member: Date:
Area Dean: Date:
Risk Management: Date:
Directions
: Complete the form in its entirety, obtain signatures, and submit to Risk Management for approval at
least 2 weeks prior to the trip.
Important note: Overnight trips require Executive Cabinet approval in addition to
Risk Management approval and must be submitted at least 4 weeks prior to the trip.
Transportation (check one)
Volunteer Activity/Excursion Form and Waiver – Updated 050319
P a g e | 3
Directions
: Fill in the following form, read and initial as indicated, and sign on page 2.
Do not leave blanks!
Name of Activity/Excursion:
Name of Class/Club:
L
oc
a
t
i
on
o
f
A
ct
i
v
i
t
y/
E
x
cu
r
s
i
on:
Participant Name:
Activity Departure Date:
Return Date:
Medical and Emergency Information:
In the event of illness or injury, I hereby consent to whatever medical treatment and hospital care is
Initial
above
deemed necessary for my safety and welfare from a licensed medical professional. It is understood
that any resulting expenses will be the responsibility of the activity Participant.
Initial
above
Unless indicated below, I certify that I have no known medical condition(s) which may pose a risk to
the health and safety of myself or others by participating in the activity(ies). I agree to advise the
District in writing below of any medical condition(s) which may be affected or in any way jeopardized
by participating in a specific field trip/excursion.
I have the following known medical condition(s):
If
none, please indicate “n/a”.
Participant’s Medical Insurance Carrier Name:
Policy Number:
If no insurance, please indicate “n/a”.
Emergency Contact Information:
Name: Phone:
Name: Phone:
Indemnification and Waiver:
Per California Education Code Section 35330 and California Code of Regulations, Subchapter 5, Section 55450,
by participating in the field trip(s)/excursion(s), I understand that I waive all claims against the District, its officers,
agents and employees for any injury, accident, illness, or death occurring during or by reason of this field trip
or excursion, including acts of negligence by the District, its officers, agents or employees. The undersigned
hereby voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for
personal injury, property damage or wrongful death occurring to him/herself arising as a result of engaging or
receiving instructions in said activity or any activities incidental thereto wherever or however the same may
occur and continue, and the undersigned does for him/herself, his/her heirs, executors, administrators and
assigns hereby release, waive, discharge and relinquish any action or causes of action, aforesaid, which may
hereafter arise for him/herself and for his/her estate, and agrees that under no circumstances will he/she or
his/her heirs, executors, administrators and assigns prosecute, present any claim for personal injury, property
damage or wrongful death against Mt. San Jacinto Community College District or any of its officers, agents or
employees for any of said causes of action, whether the same shall arise by the negligence of any of said
Volunteer Activity/Excursion Form and Waiver – Updated 050319
P a g e | 4
persons, or otherwise.
Indemnification and Waiver
(continued):
Participant acknowledges that he/she has read the foregoing Waiver and Indemnification, has
been fully and
completely advised of the potential dangers incidental to engaging in the
voluntary activity and instructing of this activity, and is fully aware of the legal consequences of
signing this form.
Participant acknowledges that if the college is not providing the transportation:
□
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 any liability, for injury or
loss which may result from my transportation;
□
Although the college may assist in coordinating the transportation and/or recommend
travel time, routes, carpooling, or caravanning, recommendation(s) or travel assistance
provided is not mandatory.
Authorization:
By signing below, Participant confirms that they are age 18 or over and that all information
included in this document is true and correct. Participant agrees indemnify the college as
indicated above.
If
Participant is under the age of 18, parent or legal guardian must also sign below
:
Signature(s):
Participant:_______________________________________________Date:
_______________
Parent*____________________________________________________Date:
____________
*Only required if Participant is under the age of 18.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Inter-Club Council Fieldtrip Check List All additional forms (Mt. San Jacinto Community College District)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 September 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document