Fill - Free fillable Student Group Travel Forms - Student Group Travel Policy PDF form

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 InState

 OutofState

 Foreign 

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Travel AuthorizationforStudentGroups/Student Date:_____________ _

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Division/Department:______________________GroupName:_________________________



(Allparticipantinformationonnextpage)

Sponsor/Advisor/CoachName:_

_________________________________________________________

(AsitappearsonpassportorDriver’sLicense)

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ADPEmployeeID:______________________________  Checkone:FacultyStaff

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TravelPurpose:_________________________________________________________________

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_________________________________________________________________

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ProposedItinerary:

Destination

DepartDate ReturnDate City State Country



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ProposedUseofFunds:

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Lodging

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$___________

 Airfareorother

CommonCarrier

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$___________

Meals $___________ PersonalAuto:___________

Registration $___________ Miles_ __________

Misc/Other $___________ Rate $___________

Cost $___________

RentalCar $___________

Total$_____________ 

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ProposedSourceofFunds:

 Fund DeptID Program Class **Project(Other) Amount

Ln1     $___________

Ln2     $___________

Ln3     $___________

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ApprovingOfficials

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______________________________________________________________________________

PrintName  SignatureDate

______________________________________________________________________________

PrintName  SignatureDate

______________________________________________________________________________

**Director,SponsoredOperationsSignatureDate

(forprojectsonly)

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UniversityFundedStudentGroupTravelAddendum

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Name

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StudentID

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Age*

ContactInfo

(PhoneNumber)

EmergencyContact

(Name&PhoneNumber)

Release

Form(Y/N)



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*Studentsunder18yearsofagemustprovidesignedreleasefromparentorguardian.

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UniversityFundedStudentGroupTravelReleaseForm

STATEMENTOFRESPONSIBILITYANDAUTHORIZATION

WAIVER,RELEASEANDINDEMNIFICATIONAGREEMENT

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ParticipationinastudenttravelprogramsponsoredbytheUniversityofWestGeorgiaand/ortheUniversity

SystemofGeorgiainvolvessomerisksincludingphysicalinjury,illness,orlossofpersonalproperty.Forthesole

considerationoftheUniversityofWest

Georgia'sand/ortheUniversitySystemofGeorgia'sallowingthe

participationinstudenttraveloranyrelatedactivitiesforwhich,orinconnectionwithwhich,theUniversityof

WestGeorgiaandtheUniversitySystemofGeorgiahavemadeavailableanyequipment,facilities,grounds,or

personnelforsuchprogramsoractivities,any

individualwhocompletestherequiredpaperworkand

participates(hereinafterthe“Participant”)herebyreleasesandforeverdischargestheUniversityofWest

GeorgiaandtheBoardofRegentsoftheUniversitySystemofGeorgia,itsmembersindividually,anditsofficers,

agentsandemployees,fromanyandallclaims,demands,rightsandcausesof

actionofwhateverkindornature,

arisingfromandbyreasonofanyandallknownandunknown,foreseenandunforeseenbodilyandpersonal

injuries,includingdeath,damagestopropertyandtheconsequencesthereof,resultingfromparticipationin,or

beinginanywayconnectedwith,theUniversityofWestGeorgia

and/ortheUniversitySystemofGeorgiaand

relatedactivities.



ParticipantacceptsthatthisReleaseandWaiverofLiabilitybytheUniversityofWestGeorgiaandtheBoardof

RegentsoftheUniversitySystemofGeorgiashallnotconstituteawaiverinwholeorinpartofsovereign

immunitybysaid

Board,itsmembers,officers,agents,andemployees.



ParticipantunderstandsthatthereisnohealthinsurancecoverageprovidedbytheUniversityduringtravel

(domestictrav elonly).Participantisresponsibleformaintainingaccidentandhealthinsuranceforindividual

protection,andmaybeheldresponsibleforanyorallhealth‐relatedexpenses,includingany

specialtravel

accommodations.Particip antabsolvestheUniversityofresponsibilityandallliabilityforanyinjuries,illnesses,

claims,damages,charges,billsand/orexpensesincurredwhileparticipatinginstudenttravel.Partici pant

certifiesthattothebestofhis/herknowledge,he/sheisingoodhealthandphysicallycapableofundertaking

thistravel.Participant

agreestoconsulthis/herphysicianconcerninganylimitingconditionsorspecial

precautionsnecessarytotheprotectionofhis/herhealth,andtoinformtheUniversityofWestGeorgiaofany

limitingconditionsorspecialprecautionsrecommendedbythephysician.

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ParticipantwillcomplywithallUniversitystandards,rules,andpoliciesforstudent

behaviorandagreesthatthe

Universityhastherighttoenforcesuchstandardsandpoliciesandmayimposesanctionsforanybehavior

detrimentalorincompatiblewiththeinterestorwelfareoftheUniversityorprogram.TheUniversityreserves

therighttodeclinetoacceptorretainanyParticipantintheProgram

atanytimeshouldhis/heractionsor

generalbehaviorimpedetheoperationoftheProgramortherightsorwelfareofanyperson.Similarly,if

conductbyaParticipantviolatesanypolicyorprocedureoftheUniversity,Participantmayberequiredtoleave

thePrograminthesolediscretionof

theUniversity'sagentsandrepresentatives,andmaybereferredtothe

appropriateUniversityofficialsforfurtherdisciplinaryorotheraction.

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ParticipantagreesthatthisState mentofResponsibilityandAuthorization,Waiver,ReleaseandIndemnification

Agreement,istobeconstruedunderthelawsoftheStateofGeorgia,U.S.A.,andthatifany

portionhereofis

heldinvalid,thebalancehereofshall,notwithstanding,continueinfulllegalforceandeffect.Participanthas

readtheabovestatementcarefully,understandsitsterms,andhasconsentedtoitstermsknowinglyand

voluntarily.

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ParticipantunderstandsthatthisAgreementshallbeeffectiveforaperiodofoneyear

fromthisdate.

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ParticipantName UniversityID# Signature* Date

 

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*Ifstudentisunder18,signatureofparentorguardianisrequired.

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