Guest Registration | Aggie Transition Camps

Basic Information

First Name: *

Middle Initial: *

Last Name: *

Preferred Name: *

Name you would like displayed on your nametag.

Sex: *

Male

Female

Date of Birth: *

Are you 18 or older?: *

Yes

Contact Information

Address Line 1: *

Address Line 2:

City: *

State: *

Zip Code: *

Home Phone: *

Cell Phone: *

Preferred E-Mail: *

Health and Emergency Information

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Relation: *

Health Insurance Compnany:

Health Insurance Policy Number:

Health Insurance Phone:

Physician Name:

Physician Phone:

Special Services or Accommodations::

Allergies:

History of:

Asthma

Heart Disease

Epilepsy

None

Medication:

Dietary Restrictions:

Please identify if you have dietary restrictions, including, but not limited to, food allergies (even if listed above in allergies), religious observances, cultural requirements, etc.

Behavior Agreement: *

The purpose of ATC is to orient new transfer students to Texas A&M University, teach them Aggie traditions, help them to connect with fellow students and develop a network of friends at A&M, and fully support their successful transition to Texas A&M University. It is in this spirit that we make this behavior agreement for ATC 2017. While University employees and trained student staff may be accompanying you to camp, it is unlikely that those persons will be able to provide constant supervision. It is expected, however, that Namesakes will abide by university policies and regulations, and all instructions presented by University staff members and Director Staff members, whether written or verbal. In exchange for being granted the opportunity to participate in ATC 2017. I will also abide by the ATC 2017 constitution, ATC policies, ATC “At-Camp” policies, and Texas A&M University Rules (as listed at http:/atc.tamu.edu and http://rules.tamu.edu/). I will do my best to contribute to the quality of ATC and the well-being of the group. ATC is an alcohol free and substance free program. As an ATC Participant, I agree to abide by the substance free policy, and understand that if I violate this policy (or any others as stated above), I may be removed from ATC. I understand and agree that if for any reason I am removed from ATC (policy violation, etc.) that my involvement with the organization ends at the time that I am removed from ATC. Please electronically sign once you have carefully read and understand completely and clearly the provisions stated above and agree to be bound thereby.

Release of Medical and Liability (Non-A&M Employees Only):

(State full name above) understand that ATC, of which I plan to be a participant, involves certain risks and that regardless of the precautions taken by ATC, some bodily injuries may occur. Specific risks/hazards involved in ATC include but are not limited to the following: (1) auto accidents while traveling to and from camp activities or traveling on the camp premises; (2) dehydration; (3) physical injury sustained while participating in camp activities; and (4) medical problems such as illness, allergies, etc. 1. In consideration for receiving permission to participate in ATC, which is sponsored by Texas A&M University, a component member of The Texas A&M University System, I hereby release, waive, discharge, and covenant not to sue, and agree to hold harmless for any and all purposes, ATC, Texas A&M University, The Texas A&M University System and its Board of Regents, and their officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES) from ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR INJURY, INCLUDING DEATH, that may be sustained by me while participating in such activity, or while on the premises that is owned, leased, or controlled by RELEASEES, including travel to and from ATC activities, including injuries sustained as a result of the negligence of RELEASEES. I understand this release does not apply to injuries caused by intentional or grossly negligent conduct on the part of the Releases. I understand ATC and Texas A&M University are separate legal entities. 2. I am fully aware that there are inherent risks involved with ATC and I choose to voluntarily participate in said activity with full knowledge that said activity may be hazardous to me and my property. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, which may be sustained by me as a result of participating in said activity including injuries sustained as a result of the negligence of RELEASEES. I further agree to indemnify and hold harmless the RELEASEES for any loss, liability, damage or costs, including court costs and attorney’s fees, that may occur as a result of my participation in said activity including injuries sustained as a result of the negligence of RELEASEES. I understand this agreement to indemnify and hold harmless does not apply to injuries caused by intentional or grossly negligent conduct. 3. I understand that RELEASEES may not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. 4. It is my express intent that this Release 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. 5. I understand RELEASEES cannot be expected to control all of the risks articulated in this form but 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 during my participation with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless RELEASEES for any costs incurred to treat me, even if a RELEASEE 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 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. 6. In signing this Release, I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing agreement that has been reduced to writing have been made. I execute this document for full, adequate, and complete consideration fully intending to be bound by the same, now and in the future. I represent that I am eighteen (18) years of age or older and am otherwise competent to execute this agreement. If the participant is younger than 18 then his/her parent or legal guardian must sign where indicated on page 2 below. I consent to the information on this form being shared with the ATC Advisors, Director Staff, and the Camp Chairs.