Burlington County College Off Campus Activity Statement

Activity: Holocaust Museum (DC) / Inner Harbor (MD)

During this activity, I understand that I am a representative of Burlington County College.

I will abide by the following

· I will adhere to the directives regarding the use of alcohol and tobacco given by the group leader. At no time will I violate local ordinances regarding the use of alcoholic beverages or tobacco products.

· I will refrain from the use of illegal drugs or the abuse of prescription or over the counter drugs during this activity.

· I will be considerate of others during the activity and during travel, specifically as it pertains to boisterous behavior and the playing of loud or offensive materials.

I understand that

· If my behavior is inappropriate I may immediately be sent back to Burlington County College at my own expense.

· If I am a college student, I may be brought to the Code of Conduct Committee for any violation of the Student Code of Conduct.

· It is my responsibility to be on time for departure from any point designated by the group leader

· In the event I am late, the group will wait no longer than 10 minutes for morning departure and 30 minutes for evening return

· In the event I am late, it will be my responsibility to pay all expenses including lodging, meals, transportation and other related expenses to my tardiness.

· I take full responsibility for the actions of my guests and for any minors in my care during this activity.

I take full responsibility for my actions and absolve Burlington County College of any and all liability.

PRINT AND SIGN YOUR NAME BELOW:

Printed Name of Participant: ___________________________________ Date:

Signature of Participant: _______________________________

If not affiliated with BCC, print name of BCC student accompanying you: _____________________

REQUIRED INFORMATION

Additional Emergency Information

Emergency Contact Name: _____________________ Relationship: Phone :

If no BCC parking sticker is displayed, list all vehicle information of car left on campus:

License Plate Number: Model: Year: Color: ________

**REQUIRED** Your Cell Phone Number: _______________________________

- - - - - - - - - - - - - - - - - - TO BE REMOVED UPON RECEIPT OF PAYMENT - - - - - - - - - - - - - - - -

Payment received on ________ in the amount of $______ for ______ seats for DC trip on ___________

Name(s) of participant(s): _______________________________________________________________

J Alexander________________________