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Status

Undergraduate

Graduate

I am an international student.

Yes

No

For more information on Graduate School Orientation and Enrollment, please visit https://graduate.utulsa.edu/resources/new-graduate-student-orientation/.

First/Given Name

Preferred First Name

Last Name

Email Address

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Primary Phone Number

Cell Phone Number

Are you yourself a veteran of the United States Armed Forces?

Yes

No

I would like to participate in

Traditional Orientation Experience: first-year students and those who transferred to TU after completing one or two semesters at another institution

Non-Tradition Orientation Event: non-traditional students, such as older adults and those who have completed several years of schooling at another institution

1. Risks of Travel. I understand that participation in the Trip may involve risks not found in study at TU. These include without limitation risks involved in traveling to, from, and within the Trip destination, as well as risks generated by the activities in which I engage while on the Trip. I recognize that these potential risks include, for example, illnesses, injuries and even death. I have made my own investigation of these risks, understand these risks and assume them knowingly and willingly. I will take every precaution to safeguard my health and to protect my personal belongings from damage or theft. I acknowledge that TU recommends that I never travel alone, particularly at night. Being alone, especially at night, may present additional danger to my safety and well-being. I understand that, although TU has organized the Trip, it cannot eliminate all risks or guarantee my safety while I am participating in the Trip. I have made the independent judgment to participate in the Trip.

2. Health Insurance; Medical Care; Health and Safety Concerns. I carry valid and current medical insurance and have a valid insurance identity card to bring. I have determined that this insurance is adequate to cover injuries or illnesses that I may sustain while participating in the Trip. I will be solely responsible for payment in full of all costs of medical care, including transportation, I may receive. I certify that if I have any special medical considerations, including food or other allergies, I have communicated those in writing to the Trip Leader listed above. I authorize TU to obtain appropriate health care for me in the event that I need it but am unable to obtain it for myself. I further agree to hold harmless and indemnify TU and its employees for any and all actions taken by TU to provide or obtain emergency medical care for me during the Trip. I also understand and agree that if I experience serious health problems, suffer an injury, or am otherwise in a situation that raises significant health and safety concerns, then TU may contact my parents or any other person whose name I have provided as my “emergency contact.” I understand that TU ordinarily will not initiate such contact without first having a discussion with me.

3. Standards of Conduct. I recognize that I assume an important personal obligation to conduct myself in a manner compatible with local laws and regulations; with TU’s policies for student conduct (including without limitation those set forth in the Student Code of Conduct and in any Trip-specific materials); with the policies of my host institution (if any); and with any instructions given by the Trip leaders. I promise to act responsibly and will become informed of, and will abide by, all such laws, regulations, policies and standards. I will comply with TU’s policies, standards and instructions for student behavior. I agree that TU has the right to enforce all standards of conduct described above.

4. Travel Arrangements. I understand that TU does not represent or act as an agent for, and cannot control the acts or omissions of, any host family, employer, transportation carrier, hotel, tour organizer or other provider of food, goods or services involved in the Trip. I understand that TU is not responsible for matters that are beyond its control, and that it cannot warrant the safety or convenience of the circumstances under which I will be living or working.

5. GENERAL RELEASE. Knowing the risks described above, I agree, on behalf of my family, heirs and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the Trip. To the maximum extent permitted by law, I release, hold harmless and agree to indemnify TU, and its officers, trustees, faculty, staff, representatives, employees and agents, from and against any present or future claims, losses, liabilities, costs and expenses for injury to person or property, or for any other damage, which I may suffer, or for which I may be liable to any other person, related to my participation in the Trip (including periods in transit to or from my destination), resulting from any cause, including but not limited to negligence on my part or on the part of any of the released parties.

Are you age 18 or older?

Yes

No

I certify that I am age 18 or older. I have carefully read and freely signed this Assumption of Risk and General Release Form. I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the State of Oklahoma (excluding its conflict of laws principles), which shall be the forum for any lawsuits filed under or incident to this agreement or the Trip.

I, the undersigned certify that I am the parent and/or legal guardian of the student listed above (the “Student”). Knowing the risks described above, I do hereby consent to his or her participation in the Trip and in domestic travel as part of the Trip. To the maximum extent permitted by law, I, as the parent and/or legal guardian of the Student and on behalf of the Student, release, hold harmless and agree to indemnify TU, and its officers, trustees, faculty, staff, representatives, employees and agents, from and against any present or future claims, losses, liabilities, costs and expenses for injury to person or property, or for any other damage, which I or the Student may suffer, or for which the Student may be liable to any other person, related to the Student’s participation in the Trip (including periods in transit to or from the Student’s destination), resulting from any cause, including but not limited to negligence on the part of the Student or any of the released parties.

I certify that I am age 18 or older. I have carefully read and freely signed this Assumption of Risk and General Waiver of Liability Form. I understand and agree that no oral or written representations can or will alter the contents of this document. This contains the entire agreement between the parties hereto and all terms are contractual and not a mere recital. I agree that this agreement shall be governed by the laws of the State of Oklahoma (excluding its conflict of laws principles), which shall be the forum for any lawsuits filed under or incident to this agreement or the Trip.

Student Electronic Signature

Parent/Guardian Electronic Signature

Date signed

Emergency Contact Information

First Emergency Contact Name

First Emergency Contact Relationship to Student Participant

First Emergency Contact Phone Number

First Emergency Contact Alternate Phone Number

First Emergency Contact Email Address

Second Emergency Contact Name

Second Emergency Contact Relationship to Student Participant

Second Emergency Contact Phone Number

Second Emergency Contact Alternate Phone Number

Second Emergency Contact Email Address

I expect to live

On campus

Off campus

Will you be participating in a Division 1 Athletics program at TU?

Yes

No

Please share with us any special arrangements or accommodations you had at a previous school (these could be part of a 504 plan or IEP).

Dietary Requests (hold SHIFT key to select more than one option)

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