CAMP SOS REGISTRATION FORM

INSTRUCTIONS Submit Registration Forms:  Electronically by emailing attachment to [email protected]  By hand to the Student Services Center Front Desk in Wrigley Hall 108  Via fax to (480) 727-9902 Questions:  Email [email protected]  Call (480) 727-6963

CONTACT INFORMATION Name (Last, First) ASU Affiliate ID (10 digit) Today’s Date

Program ASU E-mail Address Phone

BA BS

Street Address City, State, Zip Code

CAMP REGISTRATION Registration for Camp SOS for Fall (Year) Affiliation Freshman Transfer Student Ambassador Student Volunteer Staff Faculty

T-Shirt Size S XL M XXL

L XXXL

HEALTH & EMERGENCY INFORMATION Allergies and/or Dietary Restrictions

Medications Taken

Physical Limitations

I consent do not consent to the provision of emergency medical treatment tot eh extent that the treatment is necessary in the medical opinion of the physician/health care provider rendering the treatment.

If I require emergency medical treatment, please contact: Name of Emergency Contact Person: Phone Number:

pg. 1 Last Updated 4/23/2018 CAMP SOS REGISTRATION FORM

If the emergency contact person I have listed is not available, please contact: Name of Second Emergency Contact Person: Phone Number:

Insurance Company: Policy #:

LIABILITY ACKNOWLEDGEMENT All students attending Camp SOS need to accept the liability and terms and conditions statements below. If you are not 18 at the time you attend camp, your parent or guardian will need to sign this form.

RELEASE, INDEMNITY, AND ASSUMPTION OF RISK Arizona State University, School of Sustainability

By checking the box below, I am signing this Release so that I can participate in the Activities described as part of the Camp SOS experience. This Release, Indemnity and Assumption of Risk Statement covers all events, activities and occurrences associated with the School of Sustainability’s Camp SOS program including any associated necessary travel. If I have any concerns about my health or ability to participate, I agree to discuss my concerns with my physician before deciding to participate.

Additionally, I hereby grant permission to the Arizona Board of Regents, on behalf of Arizona State University and its agents or employees, to copyright and publish all or any part of photographs and/or motion pictures and/or voice recordings and/or written/spoken statements taken of me in any and/or all of the sponsored events and activities for use in university publications, including printed, moving, audio and electronic, all exhibitions, public displays, publications, commercial art, and advertising purposes in any media without limitation or reservation; and I waive any right to royalties or other compensation arising from or related to the use of the photographs/motion/pictures/voice recordings/written/ spoken statements.

I understand the risks of travel, sponsored events and activities (e.g., swimming and hiking) and agree to assume the risk that unexpected events may occur in nature and result in harm, injury or illness to myself, or damage to or loss of my property during my participation. I agree to indemnify the State of Arizona, Arizona Board of Regents, and Arizona State University and not to sue any of the named parties for any harm or damage associated with my participation or travel if the harm or damage is not due to the negligence or fault of ASU. I understand that my participation in these Activities is voluntary. In this agreement, “ASU” means Arizona State University, the Arizona Board of Regents, the State of Arizona, the School of Sustainability and their employees and agents.

Release Acknowledgement I am at least 18 years-old and agree to the above liability statement

Signature (or typed name if sending electronically)

pg. 2 Last Updated 4/23/2018 CAMP SOS REGISTRATION FORM

I am not 18 years-old and will have my parent/guardian sign below acknowledging agreement to the liability statement Name (Last, First) and Relationship to Student

Signature (or typed name if sending electronically)

pg. 3 Last Updated 4/23/2018 CAMP SOS REGISTRATION FORM

TERMS & CONDITIONS All participants must agree to the terms and conditions listed below. After reading, please check the box at the bottom to signify your agreement to the following:

TERMS & CONDITIONS

1. Know, observe and comply with the terms and conditions of this agreement, all federal and state laws, all ASU policies and regulations governing student conduct, including the Student Code of Conduct and the Computer, Internet and Electronic Communication Policy (copies of which are available upon request), and any subsequent policies or regulations that ASU may adopt or publish during the term of the agreement.

2. The integrity of the program must be considered and maintained at all times. The following behavior will not be tolerated:

Alcohol possession and/or consumption Possession and/or use of illegal drugs Possession and/or use of weapons Assault (physical, verbal or psychological) Excessive noise or disturbance Fighting, disrespect, disorderly conduct, or not following staff instructions No outside visitors are allowed during Camp

3. Personal communication/entertainment device items are restricted

4. TV sets, laptops and stereo equipment need to remain at home

5. Students will be expected to pay for any lost, stolen or damage to University property or property of the transportation to and from Camp SOS or to other activities

6. All students must remain at the camp for the duration of the camp two nights, three days

7. The camp reserves the right to dismiss a student from the camp

Terms & Conditions Acknowledgement I am at least 18 years-old and agree to the terms and conditions

Signature (or typed name if sending electronically)

I am not 18 years-old and will have my parent/guardian sign below acknowledging agreement to the terms and conditions Name (Last, First) and Relationship to Student

pg. 4 Last Updated 4/23/2018 CAMP SOS REGISTRATION FORM

Signature (or typed name if sending electronically)

pg. 5 Last Updated 4/23/2018