Fillable Student Travel Training Liability Waiver and Acknowledgment Form (Collin County Community College District)

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Student Travel Training Liability Waiver and Acknowledgment Form (Collin County Community College District)

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BROWSE COLLIN COUNTY COMMUNITY COLLEGE DISTRICT FORMS

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Dean of Students Office
Revised 8/1/2018
Page 1 of 2
Student Travel Training Liability Waiver and Acknowledgment Form
For Collin College-sponsored Trips
Participants Over the Age of 18 Years
If you are under 18 years of age, you cannot use this form.
You must complete and submit the Student Travel Training Liability Waiver and
Acknowledgment Form for Participants Under the Age of 18 Years.
Students and responsible parties* participating in academic/workforce, co-curricular, extra-curricular, or student
organization travel must complete mandatory Student Travel Training provided by the Dean of Students Office only one
(1) time during the 2018-2019 academic calendar year. Upon completion of mandatory Student Travel Training,
every student and responsible party must complete and submit this form to the Dean of Students Office. Students and
responsible parties who have not completed mandatory Student Travel Training prior to the departure
date shall not be permitted to travel.
A copy of every participant's Student Travel Training Liability Waiver and Acknowledgment Form shall be on file with the
Dean of Students Office prior to departure. Once you have completed this form, return it to the Dean of Students Office
through email or in person.
Email: studenttravel@collin.edu CHEC: Room 457 CPC: Room B-336 PRC: Room F-109 SCC: Room D-128
*Note: every athletic coach, co-curricular advisor, extra-curricular advisor, faculty member, staff member, student organization
advisor, travel advisor, or travel advisor of record overseeing approved student travel shall be identified as the “responsible
party.”
Participant's Information
First Name: Middle Initial: Last Name:
9-Digit CWID Number: Date of Birth: Collin College Email Address:
Phone Number: Role:
⃝ Collin College Student ⃝ Responsible Party
Emergency Contact’s Information
Emergency Contact's First Name: Emergency Contact's Last Name:
Emergency Contact's Relationship to Participant (e.g., Parent, Friend, etc.): Emergency Contact's Phone Number:
Dean of Students Office
Revised 8/1/2018
Page 2 of 2
Release of Liability and Student Travel Training Acknowledgment
The undersigned, being over the age of 18 years, hereby acknowledges there are certain risks associated with participating in
events and/or activities on and off campus. In consideration of Collin County Community College District (Collin College)
allowing me to participate in collegiate events and/or activities, I hereby assume all risks associated with any event and/or
activity and with the travel related thereto. I assume full and complete responsibility for any self- injurious behavior, injury,
or accident which may occur to me or the vehicle in which I am driving or riding in connection with the event and/or activity.
I also agree and authorize Collin College employees and/or agents to take any and all action they deem necessary to stop any
physical injurious behavior I may inflict upon myself or others. I release Collin College of any and all liability related to their
intervention in stopping such injurious behavior. I also agree that although I am giving Collin College the right to intervene
in these situations, they are in no way under a duty to intervene. I understand that the Family Educational Rights and
Privacy Act of 1974 (FERPA) allows for the disclosure of information from a student’s educational records without the student’s
consent to appropriate parties in a health or safety emergency. I knowingly and intentionally hereby release and waive any
and all claims, of whatsoever kind or nature, that I may have against Collin College, its Board of Trustees, employees, agents,
and representatives, resulting in whole or in part, from participation in the event and/or activity. This release and waiver shall
be binding on my heirs, administrators, and assigns.
I also agree that during the time I am involved with the above event and/or activity, I am bound by all rules, regulations, policies,
procedures, and guidelines governing me and my conduct as set forth by the Collin College department or registered student
organization, in the Student Code of Conduct (found in the current Collin College student handbook), and in the current Collin
College Student Organization Procedures Manual (SOPM).
By submitting this form, I acknowledge I have completed mandatory Student Travel Training as required of all students and
responsible parties participating in Collin College-sponsored trips. I understand and agree to comply with all applicable Collin
College policies, student travel procedures, and the Student Code of Conduct.
Participant's Signature: Date:
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Student Travel Training Liability Waiver and Acknowledgment Form (Collin County Community College District)

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Completed 6 October 2020

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