Student/Advisor Field Trip Release Form

Once the faculty/staff/or advisor has obtained approval for the Trip, then the link to this form can be sent to those participating.

All students and faculty/staff/advisors attending the field trip are required to complete this release form.

I understand that I must be 18 years of age or older to complete the Student Field Trip Release Form. Any student under the age of 18 is required to have a parent/legal guardian to complete this form.*

I verify that I am 18 years of age or olderI am not 18 years of age or older

If you are under 18 years of age, a parent or legal gaurdian is required to complete this form.

Please select field trip type:*

Class Field Trip / Off Campus Live Work Field TripStudent Organization/ Student Life Field TripAdult Education

Field Trip Attendee Name*

First NameLast Name

Parent/Legal Guardian Name*

First NameLast Name

Date*

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

900#

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you currently have a Student Discipline Record at West Georgia Technical College?*

YesNo

School Organizing Trip*

Name of Trip (provided by trip organizer)*

Name of Trip Organizer*

First NameLast Name

Email of Trip Organizer*

Please ensure the email is spelled correctly. You release form will be sent here.

First day of trip

Date

Last day of trip*

Date

Semester trip will be taken

Please select the Campus Security Authority (or registered student org advisor) that will be accompanying you on your trip. *

Student Organization or Group*

Trip Destination*

Please include city and state

Organization Main Advisor*

First NameLast Name

Primary Physician's Name/Practice*

Primary Physician's Phone*

Please enter a valid phone number.

Please list any allergies that you have including food or drug allergies: *

List any medications that you are currently taking :*

List any current medical conditions ( i.e. asthma, diabetes, heart condition) and provide your Medical Action Plan: *

In the event of an emergency and I am unable to act on my behalf, I authorize the faculty and organizers of the activity/field trip program to take whatever action they deem is warranted and appropriate regarding my health and safety.*

I agree

Review WGTC's Drug and Alcohol policy and mark "I agree" to follow the policy as outlined below:

Drugs, Alcohol and Other Substances (Listed in the Student Code of Conduct)
Substances referred to under this policy include all illegal drugs, alcoholic beverages and misused legal drugs (both prescription and over the counter).

a. Alcohol: Students must comply with all state and federal laws regulating alcohol as well as TCSG Policy II.C.6, Alcohol on Campus. Alcoholic beverages may not be served or sold at any student sponsored function. Students being in a state of intoxication on technical college Premises or at college-sponsored or supervised functions (including off-campus functions), internships, externships, practicum, clinical sites, co-operative or academic sponsored programs or activities or in a college-owned vehicle is prohibited.

b. Controlled substances, illegal drugs and drug paraphernalia: The technical college prohibits possession, use, sale or distribution of any controlled substance, illegal drugs, or drug paraphernalia except as expressly permitted by law. Any influence which may be attributed to the use of drugs shall not in any way limit the responsibility of the individual for the conduct or consequences of his/her actions.

c. Tobacco: The technical college prohibits smoking, or using other forms of electronic, alternative smoking devices and other forms of tobacco products in buildings, classrooms, shops, and labs or other unauthorized areas on West Georgia Technical College Premises

Drug and Alcohol Policy Acknowledgement:*

I agree

I understand that under state law I am required to wear my seat belt as a passenger in the vehicle in which I am riding and will abide.*

I agree

Code of Conduct

I hereby agree that in consideration of my being permitted to participate in this West Georgia Technical College field trip as a student, I will be subject to the supervision and authority of the faculty and/or director in charge. I also understand and agree that the faculty and/or director in charge has the sole authority to make decisions regarding my
continued participation in the field trip program if they determine that my conduct
warrants disciplinary action or if they determine that my continued participation, for whatever reason, poses an immediate risk of harm to me or to others. I agree that as a participant in this school-sponsored trip, I will be responsible for my own actions at all times and follow the code of conduct set forth by West Georgia Technical College as outlined in the catalog found here:

https://westgatech.smartcatalogiq.com/en/2023-2024/student-catalog/student-information/student-code-of-conduct/

Code of Conduct Acknowledgement:*

I agree

Assumption of Risk:
I hereby acknowledge my awareness that my participation in the WGTC activity may expose me to the risk of property damage and bodily or personal injury, including death. The Technical College System of Georgia and/or West Georgia Technical College will provide transportation, including activities. I understand that the risks that I may encounter include, but are not limited to transportation accidents, as well as other risks that may not be foreseeable. I have been informed and understand that there are inherent risks and dangers involved in this activity. In particular, I understand that the trip will involve the following activities:

Please list activities here: *

Release and Waiver of Liability:
I knowingly and freely assume any and all such risks and voluntarily participate in this activity. In exchange for the use of equipment, materials, and supplies and for being allowed to participate in this event, I hereby release and forever discharge West Georgia Technical College, the Board of the Technical College System of Georgia, the Technical College System of Georgia, their members individually, and their officers, agents, and employees from any and all claims, demands, rights, expenses, actions, and causes of action, of whatever kind, arising from or because of any personal injury, bodily injury, property damage, or the consequences thereof, whether foreseeable or not, resulting from or in any way connected with my participation in this activity. I further covenant and agree that for the consideration stated above, I will hold forever harmless and will not take legal action against West Georgia Technical College, the Board of the Technical College System of Georgia, the Technical College System of Georgia, their members individually, and their officers, agents, and employees for any claim for damages arising or growing out of my participation in this activity, whether caused by negligence or otherwise.

Release and Waiver of Liability Acknowledgement*

I agree

Media Release:
I grant permission for my likeness, image, and voice to be recorded in any media during this activity and to be used by West Georgia Technical College on behalf of the Technical College System of Georgia in any publications, media, or technology now known of or hereafter developed in the future for any lawful purpose whatsoever without further permission from me. I understand I will not be compensated further for using these recordings.

Media Release Acknowledgement*

I agree

Acknowledgement and Agreement

By signing below, my signature indicates that I have read and agree to the above information, rules, and regulations on this field trip. I certify that I am at least 18 years of age. I give this consent freely and voluntarily without coercion, duress, threat, or promise. I certify that I understand and have read the above carefully before signing. I understand that I am not subject to any adverse action if I do not sign.

Signature*

Transportation to the field trip*

I will transport myself to the eventI will ride in a state vehicleI will ride with a WGTC employee

SELF-TRANSPORT STATEMENT

West Georgia Technical College will provide transportation in official government or rented vehicles for the purpose of sanctioned field trips, conferences, competitive events, and other activities which involve WGTC students and employees.

In extenuating circumstances, students may request permission to use personal vehicles for transportation. If selftransportation to and from the sanctioned event is approved, the Student assumes all risk related to self transportation, waives any and all claims for injury, damage, death or any other legal claim and covenants not to sue West Georgia Technical College, the Technical College System of Georgia or its Board or any of their employees, officers or other agents.

STATEMENT OF UNDERSTANDING
I request that I be allowed to provide my own transportation to the field trip or event.

I hold West Georgia Technical College harmless from any liability in the event of damage, injury, or death incurred as a result of providing my own transportation to and from the event. Type your name below for this to serve as your electronic signature and your agreement to the terms above:

TRANSPORT STATEMENT

West Georgia Technical College will provide transportation in official government or rented vehicles for the purpose of sanctioned field trips, conferences, competitive events, and other activities which involve WGTC students and employees.

STATEMENT OF UNDERSTANDING

I hold West Georgia Technical College harmless from any liability in the event of damage, injury, or death incurred as a result of transportation to and from the event. Type your name below for this to serve as your electronic signature and your agreement to the terms above:

Read Carefully Before Signing
The undersigned hereby acknowledges that participation in field trip activities involves inherent risks of physical injury, illness or loss of personal property and assumes all such risks. The undersigned hereby agrees that for the sole consideration of West Georgia Technical College allowing the undersigned to participate in field trip activities that are in connection with which the institute has sponsored or made available any equipment, facilities, grounds, or personnel for such programs or activities or to the undersigned while participating in any such field trip activities, the undersigned does hereby release and forever discharge West Georgia Technical College and the Technical College System of Georgia, its members individually, and its officers, agents and employees from any and all claims, demands, rights and causes of action of whatsoever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, including death, damage to property, and the consequences thereof, resulting from my participation in or going out of or connected with such field trip activities.

I understand that the acceptance of this Release and Waiver of Liability and Covenant Not to Sue by the Technical College 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.

Signature (Parent/Legal Guardian if under 18 years of age.)*

Type Name*

First NameLast Name

Student/Advisor Field Trip Release Form

Emergency Contact Information

Student Organization or Student Life Field Trip

Medical Authorization

Seat Belt Notification