First Name *

Last Name *

Cell Phone # *

City *

State *

Community College Name *

Major/Minor *

Student Grade Level *

Agreement to Hold Harmless - Student or his or her heirs, executors, administrators, successors, and assigns agrees to hold harmless, defend, and to indemnify SDCOE and partners, accept any and all responsibility for loss or damage to any person or entity, including SDCOE, and to indemnify, hold harmless, and release SDCOE, its officers, agents, and employees, and event partners from and against any actions, claims, losses, damages, liabilities, disabilities, or expenses for injury to or death of any person(s), or damage to property relating to or arising from his or her participation in the activity designated in this notice that may be asserted by any person or entity, including Student or his or her heirs, executors, administrators, successors and assigns. Student’s obligations as discussed herein shall apply whether or not there is concurrent negligence on SDCOE’s and partners’ part but to the extent required by law, excluding liability due to SDCOE’s and partners’ conduct. *

Attestation - By completing this form in its entirety, I HEREBY CERTIFY AND ATTEST that I am 18 years of age or older and am an active student currently enrolled at a local community college. I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in SDCOE’s distance-based virtual student event, as described herein. *

Questions? Comments?