This is a sample trip agreement for the surfing lesson.
DO NOT print it, fill it in, etc. as it might change.
But please do read it in advance of coming to sign up, so things can go faster.
Each student must appear in person to sign up. Your friend or even your spouse can’t sign the required trip agreement and/or release form.
You (and your parent/guardian if you are under 18 years old) need to fill out and sign another release (besides the one at this page) for each Outdoor Club off campus event you sign up for; you can print one in advance at release form.
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Outdoor Club Surfing Lesson trip agreement, Sunday, May 14, 2017 at 8 a.m.
Print name______________ Phone no.__________________ Cell__________
Email______________________________
Bring own wetsuit? Y / N (Sorry, no price break for your own wetsuit, but yours will fit better.)
The rental wetsuit won’t fit unless we get an accurate Height ______ Weight_______
Age _______ Emergency person___________________Their phone______________
emerg persn’s relationship to you (mom? friend?____________________
Health Insurance: (circle) NONE or company name:______________ policy number_________________
The event begins and ends at Santa Cruz. De Anza/Foothill district, and therefore the club, does not arrange carpools, so people signed up for the trip will arrange their own transportation, pay for their own gas and parking fees. Please have the courtesy to let your driver/ passengers know of any changes to your ride needs or ability to drive. Be sure that the car you are riding in is reliable enough to get you to the event and home again.
In case of an emergency we’d like to know: Circle I will drive / I could drive but I’d prefer not to
/ I know I can’t drive, please give my phone number to potential drivers
/ I won’t drive, but I have a ride planned /I’m not sure at this time
If you will not drive, but have a planned ride, name your driver:
Make, model, color & license # of car you will drive_______________________
Number of people you could give rides to:
If you already have plans, name the people you will give rides to: ____
If you can give a ride, or need a ride, do you give the club permission to give your phone number
to anyone associated with the trip? circle yes / no
Initial next to policy statements/ safety rules to agree to them. If a minor is signing up for this event they should also initial all parts of the document alongside their parent/guardian’s initials. Use initials (don’t put an ‘X’).
FOOTHILL-DE ANZA COMMUNITY COLLEGE DISTRICT STUDENT TRAVEL TRANSPORTATION ACKNOWLEDGEMENT AND INDEMNIFICATION
College–De Anza Course number–Outdoor Club Course title- surfing lesson
Destination – Santa Cruz Date- Sunday, May 14, 2017 at 8 a.m.
I understand and accept that for good and sufficient reasons the Foothill-De Anza Community College District is not providing transportation for the field trip described above. As a consequence, I will be responsible for my own transportation whether as an individual or cooperatively with other students. I will in no respect rely on the instructor or other District employees for direction or supervision of my transportation.
Consistent with this acknowledgement, I will indemnify and hold harmless the Foothill-De Anza Community College District, its Board of Trustees, the individual members thereof, all District officers, employees and servants from all claims for money or damage arising from my transportation during this field trip.
(Initial one of the following statements)
_______ I am 18 years of age or older and I will be the participant.
_______ I am the parent or legal guardian of the Participant who is under 18 years of age to whom the above statements apply and for whose benefit I am executing this Agreement.
I have read this Acknowledgement and indemnification and understand its terms. I execute it voluntarily and with full knowledge of its significance.
Signature of Participant or Participant’s parent or legal guardian______________________
Date__________ Phone Number (s) of parent/ guardian if they signed._________________
read and sign/ initial to agree to terms on both sides of three pages
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Outdoor Club Surfing Lesson trip agreement, Sunday, May 14, 2017 at 8 a.m.
My participation in the Outdoor Club surfing lesson is voluntary and I knowingly assume all risks, including significant ones which can not be prevented. Initial ____
Waiver Participation in the the Club Ed surfing lesson carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I agree that since Club Ed will be giving me the lesson and overseeing the activity, Club Ed is responsible for my health and safety, not the Foothill-De Anza Community College District, its Board of Trustees, the individual members thereof, all District officers, employees, volunteers and servants. In consideration of being permitted to participate in any way in the field trip hereinafter called the Club Ed surfing lesson, I, for myself, my heirs, personal representative or assigns, do hereby release, waive, discharge, and covenant not to sue Foothill-De Anza Community College District, its Board of Trustees, the individual members thereof, all District officers, employees, volunteers and servants from liability from any and all claims including the negligence of Foothill-De Anza Community College District, its Board of Trustees, the individual members thereof, all District officers, employees, volunteers and servants resulting in personal injury, accidents, or illnesses (including death) and property loss arising from, but not limited to my participation on the Club Ed surfing lesson Initial _______
I know, understand, and appreciate that surfing is an inherently dangerous activity. I accept the possibility of (without limitation, by way of example:) 1) emotional distress, fatigue, exceeding my physical or emotional capabilities 2) property damage or loss 3) trauma caused by dehydration and/or weather including mild to extreme hot or cold temperatures, injuries/illness from lightning hit or near hit, being hot or cold, wet and uncomfortable 4) minor injuries such as scratches, bruises, sprains, allergic reactions, sun/wind burn, animal/insect bites, poisonous plant exposure, poisonous snakebite and other sealife or animal encounters 5) risk of head or other bodily injury from slipping/tripping/falling, (including normal terrain and/or uneven or slippery terrain) and/or being thrown by the forces of water off my feet or off of a surfboard onto rocks, piers, the ocean bottom or other people and/or their or my surfboard 6) risks related to getting to, in, on or off a surfboard caused by slippery, uneven or unstable ground or vessel surfaces 7) major injuries such as eye injury or loss of sight, broken bones, joint or back injuries, heart attacks, heat stroke, hypothermia and concussions 8) illness from swallowing / breathing in sea water 9) catastrophic injuries including drowning, eye injury or loss of sight, broken bones, dislocations, joint or back injuries, heart attack, heat stroke, hypothermia, stroke, concussions, loss of limbs, paralysis, permanent trauma and death, 10) careless or reckless behavior on the part of other members of the group despite reasonable, but not full time, supervision and careless or reckless behavior on the part of third parties and other risks that are inherent in the Club Ed surfing lesson. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. Initial _______
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Foothill-De Anza Community College District, its Board of Trustees, the individual members thereof, all District officers, employees, volunteers and servants HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in the Club Ed surfing lesson and to reimburse them for any such expenses incurred. Initial _____
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Initial _______
Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent.
Signature of Participant _____________Participant’s parent or legal guardian______________ Date_____
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Outdoor Club Surfing Lesson trip agreement, Sunday, May 14, 2017 at 8 a.m.
Initial to accept the following terms: No refunds for no-shows or people who arrive after the lesson has started, or who are late and can’t find us if we need to move to another beach because of water conditions or lack of waves _______
To participate in the surfing lessons you must pass a swim test or provide a current Red Cross or YMCA lifeguard card or scuba certification. IF YOU PAY for the trip, to have us hold a space for you, before you take the swim test or before you show us the proof of swimming ability, and you don’t show up to take the test or show us the proof, you will not be allowed to take the lesson and you will not get a refund._______
De Anza is not responsible for your transportation, so any liability is strictly yours. ________ De Anza is not giving the surfing lessons, so any liability is strictly the surfing company’s._______ If you decide to break safety rules on this trip, either De Anza ones like no alcohol or drugs allowed, or ones from the surfing instructors, you risk not being allowed to join the Outdoor Club in any other events, and possibly risk even being kicked off the trip or out of college. _____ You (or your legal guardian if you are under 18), will need to sign a release form from the surfing company ____
It’s rare, but sometimes beaches are posted as polluted by the State or County. If this happens, it might turn out that the sign was in effect during a small, temporary outbreak, but is not by the time we get there. The College has to assume a sign is in effect as long as it is posted. In this case we will have to cancel the official event and the paperwork to get people refunds can take weeks. Many people still swim or surf when beaches are posted. If you want to you will have to bring along the means of paying for the lesson.________
Initial or sign here that you have no questions or have had any questions about the trip or trip rules answered .
Signature of Participant ______________Participant’s parent or legal guardian______________________
Date__________ Phone number (s) of parent/ guardian if they signed._________________
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