Please Mail Forms & $50 Payment To: MSC LEAD Aggie Shadows, Memorial Student

Aggie Shadows DELEGATE APPLICATION IMPORTANT! Registration opens December 15th, 2008. Please do not send in forms before that date! All mail-in applications MUST be postmarked by Sunday, March 1st, 2009. Please Mail Forms & $50 Payment to: MSC LEAD – Aggie Shadows, Memorial Student Center, Texas A&M University, PO Box J-1, College Station, Texas 77844-1237

Please Type or Print Legibly Last Name First Name Preferred Name

Permanent Address City State Zip Code

Current High School Year (junior/senior) Shirt Size: S M L XL Sex: M F (Circle One) (Circle One) E-mail Address Do you request a vegetarian option? Yes No Are you interested in housing with the Corps of Cadets? Yes No College Major of Interest:

Please check all that apply: □ I will be driving myself and will need to park my car. I understand that I will be charged an additional $20 for a parking pass. I will include this payment with the $50 registration payment.

□ I will be arriving with ______by bus/car.

In case of an emergency, contact: Last Name First Name Home Phone Work Phone

Medical Information for Student: Allergies:

Medical Insurance Carrier: Policy Number:

Doctor Doctor Office Phone

***(If not applicable, please write none)*** Aggie Shadows DELEGATE APPLICATION

Please have your parent/guardian complete this section of the application: Parent/Guardian Last Name Parent/Guardian First Name

□ I give my permission for my son/daughter to attend MSC LEAD Aggie Shadows on March 29th-30th, 2009. Parent/Guardian Signature

Behavior Agreement

Aggie Shadows aims to give high school students the chance to experience college life first-hand while learning valuable leadership skills. To ensure that every student is receiving the full benefits of the conference, we ask that this behavior code be followed.

All delegates are expected to follow the University policies and regulations, which can be found at http://students-rules.tamu.edu . Delegates must not leave campus for any reason and must follow any rules or restrictions the Aggie Shadows staff implements. Additionally, being under the influence and/or use of alcohol or any kind of illegal drug is strictly prohibited. If you should fail to abide by any of these rules you will be sent home without a refund of payment.

I have clearly read and understand the Behavior Agreement stated above and I agree to be bound thereby.

______Printed Name Signature Date

□ I understand that registration is not complete until I have completed all of the following steps: 1. Complete the registration form (Pages 1 and 2). 2. Complete wavier form and Release for Permission to Photograph Form. 3. Payment (Make checks payable to MSC LEAD-Aggie Shadows). Release, Waiver, and Authorization for Medical Treatment

I, participant (or participant’s parent/legal guardian if participant is under 18 years old) ______, authorize my (my child’s) full participation in the Aggie Shadows Program, including related activities. I understand the activities are not without some inherent risk of injury. In consideration of my (my child’s) right to participate in this activity I agree to release, waive, discharge, agree not to sue, and agree to hold harmless for any and all purposes the Aggie Shadows Program, Texas A&M University, The Texas A&M University System and its Board of Regents, and their officers, employees, agents, and volunteers (Releasees) from any and all liabilities, claims, or injuries, including death, that may be sustained while participating in this activity, including traveling to, from, and for the activity, or while on premises owned or controlled by Releasees, including injuries sustained as a result of the negligence of Releasees. I understand this release does not apply to injuries caused by intentional or grossly negligent conduct on the part of Releasees. I further agree to indemnify and hold harmless Releasees for any loss, liability, claim, or injury caused by me (my child) while participating in this activity, including traveling to, from, and for the activity, or while on premises owned or controlled by Releasees.

I also give my permission for me (my child) to receive any emergency medical treatment by a healthcare professional, including emergency medical transportation, which may be required for injuries sustained by me (my child.) I agree to indemnify and hold harmless Releasees for any costs incurred to treat me (my child), even if a Releasee has signed hospital documentation promising to pay for the treatment.

Participant’s Name: ______

Participant’s Signature: ______Date: ______(18 or older)

Parent/Legal Guardian Signature ______Date: ______(younger than 18)

I agree to follow all instructions and procedures in order to maintain a maximum level of safety. Participant's Signature: ______Date ______

If the participant has medical insurance, please indicate the: Insurance Company: ______Policy Number: ______Name of Primary Policy Holder: ______

State law requires you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. RELEASE FORM PERMISSION TO TAPE OR PHOTOGRAPH

I do hereby consent and agree that MSC LEAD at Texas A&M University has the right to utilize photographs, video, or audio of me (and/or my property) and to use these for promotional material. I do hereby release Texas A&M University MSC LEAD staff all rights to exhibit this work publicly or privately. I waive my rights, claims or interest I may have to control the use of my identity or likeness in the photographs, video, or audio, and agree that any uses described herein may be made without compensations or additional consideration of me. I represent that I have read and understand the foregoing statement and am competent to execute this agreement. (Youth under 18 must have parent signature.)

______Student Name (Print) Student Signature

______Parent Name (Print) Parent Signature

______Date