Student Organizations Travel Waiver
Students have the opportunity to travel off campus through various events and and programs sponsored by student organizations. Participation in these programs is encouraged though voluntary. All students who participate in an off-campus program sponsored by a student organization must complete and submit this travel waiver prior to their participation. This agreement is effective for the academic year in which the form is submitted.

Questions or concerns may be directed to Student Life at or 212-854-2096.

Name *
Your answer
UNI/Barnard Email *
Your answer
Date of Birth *
BC ID# *
Your answer
Cell Phone *
Your answer
Local or Campus Address *
Residential Hall & Room Number or Local Address with Zip Code
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Relationship to Student: *
Your answer
Emergency Contact Home or Cell Phone Number: *
Your answer
Emergency Contact Work Phone Number or Email Address
Your answer
Medical Insurance: Students participating in trips are required to have adequate medical coverage. It is the responsibility of the student to have proof of medical insurance on her/his person during the trip.

Insofar as the student has a medical condition, it is the responsibility of said student to have all necessary medications during the trip and to administer the prescribed dosage. The student can alert the trip leader of a medical condition as appropriate. Responsibility for medication remains with the student.

I verify that I have appropriate medical insurance and will procure proof of insurance as necessary. *
As a condition of my voluntary participation, I agree and acknowledge that my participation in the optional off-campus trip is voluntary and that neither The Trustees of Barnard College, nor the College or any of its directors, officers, agents or employees, shall have responsibility for any loss, injury, or damage incurred or suffered by me in connection with my participation in this trip (including, but not limited to, any personal injury, death, or property damage).

To the extent permitted by law and in consideration for being allowed to participate in this off-campus trip, I hereby expressly waive all rights, demands, claims, and causes of action, of any nature whatsoever, whether caused by the negligence or carelessness of Barnard College, which I may have against the College or any of its directors, officers, agents or employees in connection with my participation in such a trip or activity. It is my express intent that this Waiver shall forever bind the members of my family and my estate, heirs, administrators, personal representatives and assigns.

Electronic Signature: *
Your answer
Date: *
Your answer
Permanent Address: *
Your answer
Signature of parent or guardian (If under 18 years of age)
Your answer
Your answer
A copy of this form will maintained by Barnard College. Please note that this form contains CONFIDENTIAL information and should be handled accordingly.
In case of an Emergency, please first contact local help by dialing 911 or the local authorities. Once everyone is out of immediate threat or danger, please call Student Life directly at 212-854-2096. If it is after hours, make sure you leave a detailed message and call Public Safety at (212)854-3362.
Never submit passwords through Google Forms.
This form was created inside of Barnard College. Report Abuse - Terms of Service