Short-Term, Off-Campus Program Waiver and Release Form

YOU MUST PRINT THIS FORM AND SUBMIT IT, ALONG WITH THE APPROPRIATE SIGNATURES, TO YOUR PROGRAM DIRECTOR.

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 for Off-Campus Program Travel Form (to be submitted online)
  2. Short-Term, Off-Campus Agreement and Waiver
  3. Short-Term Program Student Handbook 

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.

In addition to the above documents, some short-term programs may require additional applications, waivers and agreements which will be distributed by the Program Director.  Students must agree to the terms of these agreements in order to participate on the program.

 

____________________________
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 Banner ID #

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