Consent & Release Form
Please fill this form out prior to non-overnight travel with Chi Alpha Campus Ministries during Fall 2019. CHI ALPHA IS AN AFFILIATED MINISTRY IN GEORGETOWN UNIVERSITY’S OFFICE OF CAMPUS MINISTRY.
non-overnight travel, details:
This consent and release form is designed for students participating in Chi Alpha during Fall 2019 and thus, is in effect from August 1, 2019 to December 31, 2019. This serves to cover all of the following (but is not limited to the following): attending a group meeting off-campus (Life Group, DNA Group, etc.), participating in a weekly religious service (Weekly Worship hosted by DC Chi Alpha), travel / transportation to a weekly religious service (Weekly Worship hosted by DC Chi Alpha) by way of GU Van, ride share (Lyft, Uber, etc.), DC Bus, walking, cycling, etc.
Full Name *
Your answer
Net ID *
Your answer
Cell *
Your answer
DOB *
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Terms
I hereby understand and accept that my participation in the AFFILIATED MINISTRY's trip to the location at the dates described above (the "Trip") is purely voluntary. In consideration for being permitted to participate in the Trip, I hereby agree and represent that:

I acknowledge that this Trip is not sponsored or approved by Georgetown ("University"). Furthermore, I understand that the University is not responsible for any issue related to this Trip including but not limited to for changes of flight times, fare changes, damage, loss of baggage, dishonor of airline, hotel or other reservations, delays, losses, injuries, inconveniences, cessation of operations, airline or tour operator bankruptcies, accidents, or for the acts of defaults of any person or entity engaged in conveying participants or in carrying out other arrangements of the Trip. I understand that this Trip is being organized and run by the AFFILIATED MINISTRY, which is not a part of the University.

I understand that the Program is to be held off campus in the location described above and acknowledge that there are risks associated with traveling to and participating in the Trip. Understanding these risks, I agree that I am knowingly and voluntarily assuming them.

I agree that in consideration for being permitted to participate in the Trip, I, my parents, guardians, or legal representatives will not hold Georgetown University, its trustees, officers, employees, or agents liable in damages for any injury, death, or loss to person or property sustained by me while participating in or arising out of any travel or activity conducted by or under the auspices of the Trip.

I further agree to indemnify, defend and hold harmless Georgetown University from any breach of these representations. I have carefully read this Release and understand the above provisions and agree to be bound by them as indicated by my Full Name, typed electronic signature below.
I agree to the terms: *
Required
Additional Terms
I agree that in consideration for being permitted to participate in the Trip, I, my parents, guardians, or legal representatives will not hold Chi Alpha Campus Ministries (locally, regionally and nationally), along with any and all staff members (paid or volunteer), and other students (leaders, volunteers, attenders, members), liable in damages for any injury, death, or loss to person or property sustained by me while participating in or arising out of any travel or activity conducted by or under the auspices of the Trip.

I further agree to indemnify, defend and hold harmless Chi Alpha Campus Ministries (locally, regionally and nationally), along with any and all staff members (paid or volunteer), and other students, from any breach of these representations. I have carefully read this Release and understand the above provisions and agree to be bound by them as indicated by my signature as well as marking YES in agreement. .
I also agree to the ADDITIONAL TERMS. *
Required
Type Your Name, Electronic Signature *
Your answer
Today's Date *
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