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________________________