Waiver High School Step #3 Form Authorization*This form must be filled out by the parent or guardian if the participant is under the age of 18.Yes, I am a parent or guardian.No, I am the participant.Please have a parent or guardian complete this form.Participant Name* First Last Full Name of Parent or Guardian Completing Form First Last Email for Conformation Receipt* Media ReleaseSay Cheese!*I agree that images and audio taken during summer program activities through video and photos may be used and distributed for publication as deemed appropriate by Northland College without any limitation in space or time, and waives any rights of compensation or ownership thereto. YesNoStudent Zero Tolerance AgreementNorthland summer programs are designed to provide experiences that promote learning and team building in a safe, respectful, and positive environment. We ask that both participant and parent/guardian sign the agreement below. By signing this agreement, it is fully understood that Northland College summer programs has ZERO TOLERANCE for drugs; alcohol; and any behavior, speech, or action deemed as disruptive, disrespectful, or bullying toward instructors, participants, staff, on Northland’s campus. If such occurs, the student may be asked to leave the program.Acknowledgement of Zero Tolerance Agreement* The participant understands and has read the above student zero tolerance agreement. Expectation of Conduct & Essential Eligibility CriteriaCode of Conduct The participant will cooperate with and follow the direction of program staff, instructors, and activity facilitators. The participant will be on time and take part in all scheduled activities including instruction, tours, recreation, and evening programs. Those not feeling well or having any physical or emotional safety concerns must immediately inform program staff or instructor. The participant will be respectful of and avoid harmful behavior to self, other participants, program staff, instructors, guest speakers, private and public property, and facilities. The participant will remain in the assigned program area and assigned residential room throughout the session. Room switching and unauthorized absence from activities or residential room after “lights out” is not permitted. The participant will abide by established lights out and quiet times and will respect the privacy of others. The participant will not visit any residential rooms or bathroom of members of the opposite sex. The participant will refrain from engaging in activities if he or she does not fully understand the activity instructions or the possible consequences of the risk involved in the activity. In addition, the participant will seek out clarification from the staff or instructor before continuing with the activity. The participant will behave in accordance with applicable federal and state laws, and abide by all expectations and Policies listed in the summer handbook. Essential Eligibility Criteria The following criteria are the essential skills required to participate in the specified Northland College Summer Programs. This information is included for students to determine if they have the ability to participate. Please refer to your specific camp description for a list of activities. Hiking Able to travel in various conditions including human-made trails, rugged, rocky, uneven steep terrain; or off trail through vegetation. Able to travel in inclement weather while wearing a pack of no more than 35% of body weight. Canoeing, Stand Up Paddling Boarding, Kayaking Able and willing to wear basic protective equipment including a PFD (personal flotation device). Able to exit a capsized canoe independently (skill will be taught on site). Able to hold breath under water, independently turn from face down to face-up position in water, and keep head above water while wearing a PFD. Able and willing to control a paddle and pull it through the water in order to propel the boat. Sailing Able and willing to wear basic protective equipment including a PFD (personal flotation device). Able to hold breath under water, independently turn from face down to face-up position in water, and keep head above water while wearing a PFD. Able to move around the cockpit and secure self for boat travel and/or avoid hazards on-board. Able to exit a capsized boat, fend for self while in the water away from the boat, swim to shore, and/or grab onto another boat or rope as necessary for rescue purposes. Able to walk in shallow water with a rocky bottom in rough waves when landing or casting off. Able to enter a boat in the water from a standing or floating position with or without assistance. Rock Climbing Able and willing to wear basic protective equipment including a helmet and harness. Able to communication necessary climbing signals including hand signals, spoken signals, or a rope tug system (skill will be taught on site). Able and willing to provide a reliable belay to another climber during climbing (taught on site). Able to thread a climbing rope through a belay device (skill will be taught on site). Field Activities Able to travel in various conditions including human-made trails, rugged, rocky, uneven steep terrain; or bushwhacking off trail through vegetation. Able to travel during periods of inclement weather. Able and willing to wear basic protective equipment such as a PFD (personal flotation device), helmet, gloves, waders, etc. Participants and their families understand the program staff roles are: To serve as a supervisor and mentor for the participants; To maintain consistent supervision of participants to monitor safety, health, attitude, behavior, etc. To monitor all prescription medication and medical care; To make appropriate decisions in emergency situations for the wellbeing of participants.Acknowledgement of Expectation of Conduct & Essential Eligibility Criteria* The participant understands and has read the above expectation of conduct. Assumption of Risk, Waiver of Liability, & Agreement not to SueParticipating in Northland College summer programs may require the participant to be engaged in outdoor activities. Consequently, the participant might be exposed to certain risks due to the activities involved, unpredictable weather conditions, natural hazards, or human hazards. Participation in the program is entirely voluntary and involves a risk of injury and/or illness due to certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries, such as, but not limited to, contact with other individuals engaged in program activities, weather hazards, environmental hazards, falls, falling objects, and separation from the group during program activities. To minimize the risk of injury, the staff needs to be aware of any existing physical, mental, or emotional conditions the participant may have that could in any negative way affect, or be affected by, participation in the activity. By signing this form, you are stating that the participant and his or her parent(s)/guardian(s) have either informed the director in writing of any existing physical, mental, or emotional condition that could negatively affect or be affected by participation or have none to report. It also signifies that the participant and his or her parent(s)/guardian(s) are: 1) aware of and understand the expectations of conduct and potential hazards inherent to the activity, 2) the minor chooses to voluntarily participate, 3) his or her parent(s)/guardian(s) are allowing the minors’ participation in the activity with full consent and awareness. By signing this form, the participants, their parents or guardians, and their respective accompanying heirs, personal representatives, executors, and administrators voluntarily agree to the following: Follow the Expectation of Conduct Too assume full responsibility for any risks or loss, or personal injury, including death and damage to property that may be sustained by the participant or parent as a result of training for, or traveling to or from, or participating in any manner in the summer program; and To release, waive, hold harmless, discharge it from any and all liability, and agree not to sue the person or entity responsible for administering the summer program, Northland College, or its trustees, employees, participants, staff, and any other persons affiliated with the summer program, as well as their successors from all claims, losses, damages, and causes of action whatsoever arising out of the undersigned's participation in or traveling to or from the summer program, or from the facilities and equipment in place or as a result of, or incident to, the summer program. This release is intended to be the most expansive release allowed under the applicable law. If any part of this release is deemed invalid, illegal or unenforceable in any respect, the enforceability of the remainder of this release and agreement will continue in full force and effect. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including the right to sue. Understanding and Assumption of Risk* I understand and have read the above assumption of risk, waiver of liability, and agreement not to sue. AcknowledgementAgreement of Participant*By entering the participants full name in this field you are agreeing that the participant accept the conditions of Northland College's 1) Expectation of Conduct; 2) Student Zero Tolerance Agreement; and 3) Assumption of Risk, Waiver of Liability, and Agreement not to Sue. Name Agreement of Parent or Guardian*By entering your full name in this field you are agreeing that you have read and accept the conditions of Northland College's 1) Expectation of Conduct; 2) Student Zero Tolerance Agreement; and 3) Assumption of Risk, Waiver of Liability, and Agreement not to Sue. Name Date* Complete Step 3Clicking "submit" will send your release and waiver form to us and take you to step 4, the climbing wall waiver.NameThis field is for validation purposes and should be left unchanged.