SALT Camp

First Name	*
Middle Initial
Last Name	*
Name you want on name tag	*
TAMUG Student ID Number (UIN)	*

Permanent Street Address	*
Address Continued
City	*
State	* Use the two letter abbreviation.
Zip Code	*
Permanent Phone	* ###-###-####
Cell Phone	###-###-####
E-mail	*

Gender	Male Female *
Date of Birth	* mm-dd-yyyy
Current Age	*

TAMUG Major	*
If you are a transfer student, what school are you transferring from?
Classification	*
Hometown	*

Friday Lunch sandwich choice	*
Friday Lunch drink choice	*
T-Shirt Size	*
Please list any special concerns, both medical and dietary (i.e. allergies, medications, disabilities, etc.)
Do you have any siblings?	Yes No
What are your hobbies?
Please share with us any outstanding achievements:
What interesting places have you visited?
What are your favorite things? (i.e. color, music type, places, etc.)
What do you usually spend your summers doing? (work, vacation, etc.)

SALT Camp 2013 Waiver, Indemnification, and Medication Treatment Authorization Form
1. EXCULPATORY CLAUSE. In consideration for receiving permission for my/my child’s participation in any and all activities of S.A.L.T. Camp 2013 (herein referred to as “camp”), which is sponsored by TAMUG Office of Student Life, (herein referred to as “sponsor”), I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, Texas A&M University, and their members, officers, servants, agents, volunteers or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me/my child while participating in such activity, while traveling to and from the activity or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
I have read the above EXCULPATORY CLAUSE: Enter your initials to signify your agreement.*
2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself and others involved with this activity, including but not limited to risks associated with travel, risks associated with outdoor activities including, but not limited to sunburn, dehydration, and insect bites and I choose to voluntarily participate/allow my child to participate in said activity with full knowledge that the activity may be hazardous to me, my child and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I agree to indemnify and hold harmless INDEMNITIES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, which may occur to myself, other participants, and third-persons as a result of my participation in said activity, including injuries sustained as a result of the sole, joint or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITIES.
I have read the above INDEMNITY CLAUSE: Enter your initials to signify your agreement.*
3. NO INSURANCE. I understand that RELEASEES may or may not maintain any insurance policy covering any circumstance arising from my/my child’s participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Organization may not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so organization, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance.
I have read the above statement regarding NO INSURANCE: Enter your initials to signify your agreement.*
4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas.
I have read the above statement regarding BINDS HEIRS: Enter your initials to signify your agreement.*
5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my/my child’s participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITIES for any costs incurred to treat me/my child, even if an INDEMNITY has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me/my child while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
I have read the above statement regarding MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER: Enter your initials to signify your agreement.*
6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; organization has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself and my child from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me/my child that has a lower level of risk to myself and my child. I further understand this is a voluntary, extracurricular activity. While I understand alternative activities are available to me/my child that do not have the risks associated with this activity I still desire to voluntarily engage in this activity.
I have read the above statement regarding VOLUNTARY SIGNATURE: Enter your initials to signify your agreement.*
In case of emergency, contact: * at * ###-###-####
If the participant has Medical Insurance:
Signing this document involved the waiver of valuable legal rights. Consult your attorney before signing this document. The below information represents your digital signature for the SALT Camp waiver form. Please fill out the information below in its entirety.
Signed this * day of ,* *
Participant's Full Name: *
Participant's Date of Birth: * mm-dd-yyyy
Parent's or Legal Guardian's Full Name: (if participant is under 18 years of age * )