May27-June 1, 2015
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BYU IDAHO BYU-ldaho Nauvoo Student Tour Student Information & Agreement Form May27-June 1, 2015 US Citizen: YES NO City _ State _ Zip _ Cell Phone: _______________ I-Number________________________ Parent's Names: ________________________________________________ Parent's Address: ________________________________________________ City State:____________ Zip Parent's Phone #'s: ________________________________________________ Contracted Rules and Regulations: 1. I agree to the code of honor and dress and grooming as stated in the BYU-ldaho catalog and application forms for attendance at the university or any of the sponsored programs. This includes no shorts, Capri pants, tank tops or sloppy tops, no suggestive or vulgar apparel, or abbreviated or see-through apparel. 2. I agree to any curfew established by the tour director and promise to keep all rules. 3. I agree that if I should break any tour rules or nay rules of dress and grooming and it is deemed serious enough by the director that I return home, all expenses incurred will be at my own or my parent's expense. 4. I agree to provide my own health and accident insurance. If I am covered by my parent's policy I agree that Iwill not hold the school liable for any accident incurred. If I have no insurance coverage I agree to purchase insurance through BYU-ldaho before leaving for the trip. Applicant's Signature _________________________________ Date________________ STUDENT AUTHORIZED ABSENCE POLICY All field trips, athletic events, tours, etc. approved by a department chairman, athletic coach, or tour director as part of the regular program of the university are official school activities. All activities and events should be planned in advance of each semester so that students may know what absences will be required in order to notify their instructors in advance and plan their work accordingly. Faculty may not cut student grades on the basis of attendance if the absences(s) are for official sanctioned activities. In the event that the student is doing poorly, the instructor should inform both the student and the activity or event sponsor of the deficiency. The sponsor must submit a list of all students involved in the activity to the Dean of Students Office at least one week prior to any sanctioned activity lasting more than one day. The list should include the dates of the activity, a travel itinerary, and the name of accompanying chaperones, faculty, staff, and administrators. Absences or nonattendance for reasons other than official school activities may result in a grade cut. OFFICIAL BYU-IDAHO STUDENT ABSENCE REQUEST Name: Student No.: Activity: Nauvoo S tudent Tour Date & Time: May 27, 2015, 5:00 p.m. –June 1, 2015-6:00 p.m. This student understands that he/she is responsible to contact you (instructor) in advance of the absence(s) to arrange for make-up work. Please provide the opportunity for this student to make up work missed during his/her absence. He/she understands the ramifications of the policy provided above. Sponsor: Department of Religious Education Phone: 208-496-3921 John Thomas 496-3956 STUDENT RESPONSIBILITY & ACKNOWLEDGMENT Name: Student No.: I understand that I am responsible to make contact with the instructor of each class I will miss prior to the absence and to make up any work which I have missed in my classes during my absence(s) and that some classes have unique labs or class projects, which due to their nature or complexity may not be duplicated for my benefit. I also understand that it is not incumbent on any instructor to redo a specific class environment because of my absence. Signed: Date: BRIGHAM YOUNG UNIVERSJTY IDAHO Activity Waiver - Nauvoo Student Tour Name of Class, Activity, or Tour !Nauvoo Student Tour J Beginning Date of Activity: May 27, 2015 Ending Date of Activity: June 1, 2015 Description of class, activity, or tour. Hereinafter called "Activitv'' Travel by bus from Rexburg, Idaho to Missouri (Independence, Kansas City, Liberty, Richmond, Far West, Adam-ondi-Ahman) to Illinois (Carthage and Nauvoo), to Council Bluffs Iowa, Omaha Nebraska, Martin's Cove Wyoming, and back to Rexburg, Idaho. The activity will also include walking tours at church and state historical sites in Independence, Richmond, Far West, Adam-Ondi-Ahman, Nauvoo, Carthage, Kanesville Tabernacle, Winter Quarters, and Martin's Cove. Description of risks and hazards of the Activitv* The hazards associated with travel, including auto, or bus crashes; hazards of walking or hiking, such as falls, crashes, being struck by a vehicle, or suffering physical exertion; hazards of storms; hazards of hate crimes; illness caused by food, water, heat, cold, altitude, or contagious disease; assault, theft, or robbery; trip cancellation or change in itinerary and travel plans; acts of God; any activity I decide to participate in during free time, etc. In consideration of being permitted to participate in the Activity and understanding the risks that are involved, I know and recognize that participation in the Activity conducted by Brigham Young University-Idaho is done on a voluntary basis without compulsion or coercion and is not a mandatory class requirement or if it is a mandatory class requirement, I have chosen to make my own travel arrangements and assume all risks and responsibilities accordingly. Iknow there may be dangers and hazards associated with the Activity and assume the risks associated with participation in the Activity, including but not limited to those risk and hazards described above. I acknowledge that these hazards could cause physical or emotional harm or even death. Furthermore, Itake full responsibility for any activities Iparticipate in during free time and any personal deviations from the above Activity. Iassume all risks associated with the personal activities and deviations. Knowing the risks, and in consideration for being permitted to participate, and as inducement to BVU• ldaho to permit me to participate in this Activity, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue and waive, release, and discharge BYU• ldaho, its agents, officers, and employees from any and all claims or liability for death, personal injury or property damage of any kind or nature, and any other claims whatsoever arising out of or in any way connected with my participation in this activity, even though liability may arise out of carelessness on the part of BVU-ldaho, including its officers and employees. This release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. MY SIGNATURE BELOW AFFIRMS THAT I HAVE CAREFULLY READ THIS WAIVER AND THE ASSOCIATED TERMS; I UNDERSTAND ITS CONTENT AND PURPOSES, AND IVOLUNTARILY AGREE TO ALL THE TERMS SET FORTH ABOVE. Participant's Name _________________________________ (Please Print) Participant's I-Number Participant's Signature _________________ Witness Signature___________________________________________ Date_____________________ Parent/guardian Signature __________ Date_____________________ (Required if participant is under 7 8 or a dependant of parent/guardian) FIN SVCS 05/2012 BYU Department of Religious Education IDAHO 202 Taylor Building • Rexburg, ID • 83460-1510 • Phone: (208) 496-3920 Nauvoo Student Tour Student Medical History Form May 27-June 1, 2015 Date / / Birth Date /_/ _ Year in School_____________________ I-Number _____________________ Local BYU-1 Address. _ Parent/Guardian Names(s) _________________________________________ Parent/Guardian Cell Phone(s) _____Home Phone. _ Parent/Guardian Work Phone E-mail______ Do you have any health concerns such as allergies, diabetes, epilepsy, heart or chronic conditions that the program directors should be aware of? Y N Please list and describe all current conditions and medications. Emergency Contact (other than parent or guardian): _____________________ Relationship: ___________________ PhoneNumber: _______________ Name of Insurance Provider_____________________ Policy Number: Insurance Contact Number: -_- BYU Department of Religious Education IDAHO 202 Taylor Building • Rexburg, ID • 83460-1510 • Phone: (208) 496-3920 Nauvoo Student Tour Travel Information and Needs Check List As you will be able to see by the itinerary, this trip is fast and furious. Packing properly and coming prepared will make the trip more enjoyable for everyone. We hope that these reminders will help you in your preparation. 1. We will represent the University wherever we go. Please remember that this is a BYU-Idaho sponsored trip and that every aspect of the BYU-I Honor Code is in force throughout the trip. 2. Please remember that you will be traveling with a group. When people choose to do "their own thing" it not only affects them but the whole rest of the group. Please be where you are asked to be when you are asked to be there! 3. Please remember that you will be responsible for providing 12 meals for yourself. You will need money for, D 2 Breakfasts (F/M) D 5 Lunches (Everyday) D 5 Dinners (W/Th/F/Su/M) 4. Please bring your scriptures with you as we will be using them every day. 5. Below is a list of things that you will want to bring with you. D Homework D Scriptures D Hymn Book D Temple Recommend (if you plan to go) D Camera D Full Water Bottle D Medication (Prescription; Motion sickness; Headache; etc.) D Tooth Brush & Tooth Paste D Deodorant D Soaps (Hand soap; small shampoo; etc.) D Small wash towel D Small hand towel D Comb / Hair Brush D Shaving razor D Pajamas D 4 changes ofunder clothing D 1Set of Church Clothes D 2/3 pair of comfortable pants (No Shorts) D 2/3 comfortable shirts or blouses D 1Pair of comfortable walking shoes D 1Rain poncho (Umbrella) D 1Light/Medium jacket or sweater (It will probably be cold and windy at Martin's Cove) D Pillow and blanket for the bus D (Females) - Feminine supplies .