Short-Term Off-Campus Program Waiver and Release Form

AGREEMENTS/WAIVERS SIGNATURE FORM

All participants of short-term off-campus programs should print this form and submit it to their program director after signing. 

By signing this document you are confirming that you have read, understand and agree to the terms on the following Agreements, Policies, Forms and/or Waivers:

1. Health & Emergency Contact Information (to be submitted online)
2. Waiver of Rights and Release of Liability Agreement
3. Program Participation Agreement
4. Authorization to Release Protected Health and Dietary Information
5. Code of Honor 

All of the above documents are available for download from this website and paper copies will be made available to any applicant upon request. I have read and understand the above documents and I agree to all terms and conditions of these documents made effective with the date of my signature recorded below.

____________________________
Applicant’s full name (Print)    

_____________________________     ______
(Signature of Applicant/Participant)      Date

____________________________
Parent/Legal Guardian's full name (Print)   

_____________________________      ______
(*Signature of Parent/Legal Guardian)    Date            

___________________________________        _____________________
(Short-Term, Off-Campus Program)                           CSB/SJU ID #

*Parent or Guardian signature is necessary unless the student is not considered a dependent for federal income tax or financial aid purposes.