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Germanna

Community

College

Clubs and Organizations:

Student Leader and Advisor

Handbook

2016-2017

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Table of Contents

Intro………………………………………..................3

Starting a New Club ..…………………………….. 4

Sports Clubs, rec. events……….…………………….5

Event Requests and Planning….……………………..6

Publicity, Room Reservations..……………………....8

Club Funding…….…………………………………..10

Budget Request Form……………………………......12

Club Registration form……………………..………..15

Club Advisor Agreement ………………..…………..17

Event Registration Form…………………….………18

Sample Constitution………………………..…….20-24

Sample Assumption of Risk…………….…………...25

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Thank you for your interest in

Student Leadership!

Extracurricular activities can be a memorable part of the college experience. They allow

students and faculty to indulge in their common interests, whether they are social, cultural,

recreational, academic, community-based, or a combination. Involvement in student

organizations, events, or community service offers a variety of benefits. Members gain

experience in leadership and teamwork, are able to develop new skills and interests, and as a

result form new and lasting friendships.

ABOUT THIS HANDBOOK:

We want to inform student leaders and staff/faculty advisors about the processes for student clubs over

the course of a year. It also mentions resources available for student clubs or organizations: you can

book rooms, create a fund account under Student Activities, request funding, and publicize your

upcoming events.

Most required documentation is included in this handbook. For forms which must be turned it, please use

copies attached to end of this handbook. There are also samples of documents such as the Sample

Constitution, which can be used as a reference.

Please do not feel overwhelmed by the paperwork or content of this packet: it is designed to answer as

many questions as possible. If you have further questions, please feel free to contact the Student Activities

Department.

For students and advisors, thank you for your service!

Questions:

Sandi Pope, Student Activities Coordinator Spope@germanna.edu

540-891-3004

Steven Christian, Student Activities Assistant SChristian@germanna.edu

540-834-1004

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Starting a New Club

Student clubs and organizations can involve interests that are social, recreational, cultural, academic,

political, artistic, skill-oriented or co-curricular.

Requirements:

1. At least 8 student members, and sufficient officers to fulfill mission. Members must be currently

enrolled. The club president or designee will be required to attend all SGA meetings. Officers must

maintain at least a 2.0 grade point average, or in some cases higher if it is a requirement of a national

organization (Phi Theta Kappa).

2. An Advisor: either a staff or faculty member at Germanna, to sponsor the organization. Specific duties

of Advisors are outlined in the Advisor Form.

To schedule a meeting with the SGA, or to contact Student Activities Staff with inquiries:

Sandi Pope, Student Act. Coordinator: spope@germanna.edu 540-891-3004

Steven Christian, Student Act. Assistant: SChristian@germanna.edu 540-834-1004

Completed Student Club Registration Form (Page 15)

Form Includes – Club Name, Club Purpose, Club’s regular or scheduled meeting time, name and

contact info for 3 member / officers, name and contact info for advisor.

Club Advisor Form (Page 17)

Form Includes – Purpose, responsibilities of advisor, and relationship with student group

members, this should be submitted annually or if a change occurs mid-year.

Club Constitution

There is no length requirement for the constitution, but a document which includes organizational

guidelines must be included (Sample Constitution included in back of this packet, pages 20-24) It

can address why the org. is being formed and how the org. will be run.

Clubs with regional, national, or international affiliation must include a copy of the affiliate

organizations constitutions or bylaws.

3. Meeting with Student Government Association. The purpose is to discuss the vision of the club, what

the plans are, what the format will be (some clubs might just need a room to meet in, some have larger

projects), number of members, etc. The Student Government will vote on approval, which will be sent

to the Dean Frederick of Student Services for final approval. The Assistant Dean of Student Development

has final approval.

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Sports Clubs and Recreational Events

Sports clubs at GCC are facilitated through intramural adult leagues such as Fredericksburg Field House.

All comply with Title IX.

Sports clubs or recreational activities have special concerns from other clubs due to equipment needs,

eligibility criteria, and the potential for injury. In response to those concerns, the following policies must

also be adhered to in addition to the standard club policies.

Assumption of Risk Forms:

Assumption of risk forms must be completed by every student participating in a sport or recreational

event of any kind. There is a sample ‘Assumption of Risk Form’ for basketball as a reference, but a given

club or event may have different risks, in which the form would have to be edited or updated. To make

sure nothing was left out, please send a copy of the Assumption of Risk form to Club Advisor prior to

collecting signatures.

Equipment:

Sports and recreational clubs require more equipment. In order to not burden the clubs with high

fundraising goals before they can start, Student Activities will consider funding requests for equipment

that is to remain property of Student Activities. If you are in need of equipment, please see the Student

Activities Coordinator prior to filling out a ‘Budget Request Form.’ Please make your quotes as specific as possible. Equipment will be checked out to the student leader of the club for the season. Student

Activities has some storage space for items when not in use.

Event Requests and Planning

Activity/Event Planning

GCC student events and activities must be approved by the Student Activities Coordinator, Sandi

Pope. Groups seeking to host activities must submit an ‘Event Request Form’ at least 3 weeks

prior to the function. If the event requires funding, the funding request must be made in the first

6 weeks on the semester.

Event Registration Form (Page 18):

Information on date, location, set-up details and organization(s) participating will be

required.

Description of event: What type of event, description of activities, and purpose, which

often varies from group to group, or event to event.

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Contact info for primary students involved and organization advisor. If the event is not

affiliated with a specific organization simply contact the Student Activities Office prior to

submittal of form.

EVENT PLANNING…

Consider the following in planning an event:

Type of Activity: How does purpose and objective fit with the organization? Will it benefit the

college community?

Audience: Who do you hope to attract? What is the best way to reach them? How many people

do you expect?

Location: Is it logistically sound? Is there enough space? Has it been approved?

Security is required for events taking place after business hours.

Food: Cost? Is it the right amount? Too much? Too little? How is it prepared? Health Dept.

Concerns?

Workers: Who will be there to set up? Who will be there during the event? Who will be there

for clean up?

Time: How will timing impact participation or the potential audience?

Approval: Have you contacted S.A.? Done the budget request, event request, or room request

forms ahead of time?

Have you contacted your club advisor and properly prepared any necessary documentation

Transportation: GCC vehicles are available for use but only faculty and staff are eligible

drivers for College vehicles

Liability: Were ‘Assumption of Risk’ forms filled out and turned in?

Publicity: Did you give the event at least 2 weeks of publicity?

Alternative plan: If outdoors, have a backup plan for rain. Choose alternate sites or times.

BEFORE THE EVENT

Brainstorm with group about ideas for an event. Plan a budget if necessary.

Submit an Event Request Form, a Budget Request Form (if necessary), or a Room Request (if

necessary)

If you have an approved budget request, save your receipts and documents.

Read the above section, ‘Event Planning.’

Have a prepared sign in sheet for all who are in attendance/food participants

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DURING THE EVENT

Know who is scheduled to do what.

Take pictures if you have the opportunity

If serving catered food which was paid for by Student Activities budget, PLEASE, get a sign in

sheet of those who ate! Student Activities must turned these in with receipts to the Business

Office.

Safety first, know the location of first aid and emergency contact info is for club members in

case of emergency.

AFTER THE EVENT

Clean up (select clean up volunteers ahead of time)

Submit any receipts or food sign-in sheets to the Student Activities office.

Think about what went well and what can be improved upon

Thank everyone who attended or helped!

Publicizing Organizations,

Events, and Meetings

Prior to posting information for a meeting or event, please notify the Student Activities

Department so we can post track it on our calendar. Here are some common forms of

publicizing:

Student Activities Representatives can send an email to all students for a specific event or

meeting for a club or organization. (If you are a student you may have noticed them in your

Germanna Inbox.)

Flyers / Posters – Must be stamped be the Welcome Center/Front Desk before posting..

Specific bulletin boards for student use are located at all locations.

Flyers may not be posted on windows, building entrance/exit doors, or car windshields

Germanna Homepage Calendar – At www.germanna.edu, there is a calendar of upcoming

events, through active data, on the front page. If you would like, your advisor can add your

event here as well.

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Germanna Student Activities Facebook page

1 minute presentations at beginning of a class, with instructor’s permission

Contact Student Activities Coordinator about official College Public Relations

Room Reservations

On-Campus room and space reservations for student org. meetings or activities must be made by

your advisor.

Room Request – Email these details to your advisor who can reserve a room for your

club, and your advisor will receive two emails back: a confirmation of your request, and a

second confirming the room reservation itself.

Organization or activity involved, date(s), if it is a single event or, for example, takes

place on a monthly, weekly, or bi-weekly basis, etc…starting and ending times, which campus for event, and set up reminders.

Club Funding

There are two main methods of funding a particular club. One would be fundraising through various

activities such as bake sales, etc. The other is for an organization and its leaders to submit a ‘Budget Request Form’ to Student Activities.

Budget Requests

Student organizations may apply for funding through the Student Activities Office. Requestors must take

into consideration how their funding is enriching the lives of students, Germanna, or the college at-large.

Here are the Budget Request Guidelines:

All budget requests should be recommended by the Student Government Association at a

formal open meeting prior to the first 6 weeks in the semester. If supported your request

should be hand carried to the Student Activities Coordinator by the student club

representative. If not supported by the SGA, the decision may be appealed to Assistant

Dean of Student Development for review and final decision. Priority will be given to budget

requests supported by the SGA.

Funding is available to established and newly formed clubs on a first come first serve basis

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All groups requesting funds must have an advisor

Budget Requests must be submitted to the SGS/Student Activities Coordinator during the

first 6 weeks of the semester. Proposals will be reviewed. Groups will be notified of the

response of the proposal. Final approval is made by the Assistant Dean of Student

Development, in accordance with the VCCS policy.

Requests will be allocated based on this criteria:

Relationship between request and the club mission statement/purpose

Request should demonstrate or relate to at least three of the following:

1) Programs sponsored by the club in the past 12 months were successful.

2) Program has an educational value

3) Program encourages interaction among students.

4) Program supports student commitment and loyalty to the college community.

5) Program will be visible and accessible to all students.

6) Program is designed to promote a diversity of student interests

Club has shown fiscal responsibility. Were forms turned in on time? Were proper

procedures followed? If there were funds granted in the past, were the used in the correct

manner? Has the club provided justification for any of these issues? Has the club

demonstrated a history of fiscal responsibility?

Research and planning has taken place to ensure the feasibility of the event.

College policies will not be violated by the program or event

Estimates of expenses and revenues are reasonable.

Research has been done to provide an accurate estimate of expenses.

Funds may be allocated a percentage of the total requested, total cost of the event, or

denied completely.

Student Overnight Travel will be limited to participation in regional, state, or national

organizations, co-curricular competitions or conference related to the club mission, and

approved by the Dean of Student Development.

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Funding will be NOT be used for any of the following:

Charitable contributions (students may participate in charitable activities)

Scholarships

Compensations for services if the individual is a member of the club or organization

Funds to provide financial support to off-campus organizations

Products that violate college policies

Anything that promotes or has the potential to promote violence, illegal activities,

defamation of individuals, or defamation of groups.

Direct contributions to a specific political campaign or party

Fundraising

Another option is fundraising to help an organization earn money for charitable or large projects

and expenditures. Fundraisers are an activity and require an ‘Event Request Form,’ outlining

what the fundraiser will entail. The Office of Student Activities has a cash box available and

seed money can be attained with at least 3 weeks’ notice. Please reference fundraising policy in the Germanna Student Catalog for more information and policy on external fundraising.

Funds Management

All monies collected from fundraisers by student clubs and organizations must be deposited with the GCC

Business Office. Any club requiring an account should notify the Student Activities Coordinator. No

student group should have an outside bank account. Monies deposited with the Business Office will carry

over from year to year. Remaining club funds will be moved to the Student Government Association

account if a club becomes inactive after 2 years.

- ‘Cash Transmittal Forms’ can be obtained from the Student Activities Office, and a student activities representative can help with managing the club account. Money must be counted before submitting.

Student Activities will submit the Cash Transmittal Forms to the Business Office.

-Funds deposited with the Business Office account can be accessed by submitting a check request to the

Student Activities office. Please DO NOT send directly to the GCC Business Office without

notification, as Student Activities must track all transactions as well. Please allow 10-15 business days

for processing.

For staff and faculty, ‘Check Request Forms’ are available on the Germanna Central under

business office forms

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Students must go through a Student Activities representative or faculty/staff advisor, as Check

Requests are unavailable for students.

Keep copies of receipts, agendas, and forms.

‘Sign-in Sheets’ are also required for catered events, including a names, signatures, and the date.

Anyone who eats or drinks must write their name and signature. It is necessary for tracking food

expenditures for the State Budget. (This does not include fundraisers)

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Budget Request Form Due Within First 6 Weeks of the Semester

*Contact Information*

Name:

Name of Org (if applicable):

Contact email address:

Phone Number:

Address:

City, State, Zip:

1) Please summarize your expenditure. What is it for? What activity/event will occur? When will it

start and end, and which date(s) will it take place? Who is the intended audience? Any other details

which are important?

2) How does this connect with the purpose of your organization, or the Germanna Community? Is it

educational, promoting social interaction among a group of students, open to every student? Or,

what are its benefits?

3) Please list or attach as detailed a list of expenditures as possible. What is the total amount you are

requesting? How is it broken down? If there are estimates or approximations for expenses, please

indicate this. (There is also room for this on next page, if your expenses are event or travel related.)

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Budget Request Form Cont.– Event(s)

*Please fill out any information which applies to your event*

1) Entertainment – List any expenses that will be incurred to pay for performers. Include costs and

name of individual or act.

2) Include any materials you will be purchasing as well as how much the items cost.

3) Publicity – Include items you will use to publicize the event and how much those items cost.

4) Food – Indicate food items you would like to purchase, as well as the cost for each item, as accurate

as possible

5) Other - ?

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Budget Request Form - Travel *Please fill out any information which applies to your event*

1) Transportation – Include car rental or mileage, parking, airlines, train, etc.

2) Lodging – Include the cost per night, the number of nights and any taxes that will be charged.

3) Registration Fees – Indicate how much it costs per person to attend and how many people are

planning to attend.

4) Food – How will the food be paid for?

5) Advisor – who is the advisor that will be attending?

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Student Club Registration Form

Submit completed form to Student Activities, FAC, RM 100A or contact Student Activities at

Sandi Pope OR Steven Christian

Student Activities Coordinator Student Activities Assistant

Spope@germanna.edu SChristian@Germanna.edu

540-891-3004 540-834-1004

FAX: 540-710-2092 with a Cover Page to direct it to the

Student Activities Coordinator’s Office

Club Name: __________________________________________________________________________

Club’s Purpose (in 60 words or

less):________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Club’s regular meeting time and location:___________________________________________________

*Please list three students, currently enrolled at GCC who serve as officers.

Name:_______________________________________________________________________________

Email:_________________________________________ Phone:________________________________

Address:

_____________________________________________________________________________________

_____________________________________________________________________________________

Name:_______________________________________________________________________________

Email:_________________________________________ Phone:________________________________

Address:

_____________________________________________________________________________________

_____________________________________________________________________________________

Name:_______________________________________________________________________________

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Email:_________________________________________ Phone:________________________________

Address:

_____________________________________________________________________________________

_____________________________________________________________________________________

Advisor’s Name:_______________________________________________________________________

Email: ________________________________________ Phone Number:_________________________

Do you intend to request College funds for your organization (For future reference)? Y N

Other Club Members / Club Roster:

Name (GCC)Email Phone Address

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Club Advisor Agreement

Purpose and Responsibilities:

Voluntarily serve student organization by providing information, direction, enthusiasm and continuity to

the members and officers of the organization

To be informed on what the organization is doing/planning by attending 90% of the meetings

An advisor must submit room reservations via active data and sign ‘Event Request’ or ‘Budget Request’

forms for club projects and submit maintenance requests via Germanna website

Student goals and ideas should be discussed with an advisor

Maintaining contact with Student Activities Office

Explaining College policies and appropriate behavior during meetings and/or events

Organization’s Responsibilities to Advisor: Be aware success or failure of organization rests on the members of the organization

Clubs are student run, and once a student leader is established, advisor is not responsible for calling or

running meetings

Consulting advisor when event planning or making organizational changes

Acknowledge advisor has other demands, being courteous when planning activities where chaperone is

required (events and travel).

Agreement:

I agree to be the advisor of: ______________________________________________________________

I recognize the duties of an advisor and agree to fulfill the above responsibilities.

Name:______________________________________________

Title:_______________________________________________

Email______________________________________________ Phone: ___________________________

Date: _____________ Signature: __________________________________________________________

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Event Registration Form

Date(s) of Event: ______________________

Location: (Circle) - FAC LGC DTC SCC

Other_____________________________________________________________________

Space___________________________________________

Summary of Event: What is it? What is the purpose? What/Who will it involve?

Expected Audience – Approximately how many? ______________

Who will be there? (e.g. students, GCC community and guests, general public, etc.)Remember

that only students can attend events paid for with Student Activity funds.

Time:

Set up begins: __________________ Event begins:___________________

Event ends: ____________________ Clean up ends:__________________

Are there special set-up needs for the event? If so, please describe below:

*Are you collecting money on site? If so, be sure to have a ‘til’ to make change according to

the prices of items being sold or admission.

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Continued…

Organization Name:

Primary Contact Name:

Phone: ____________________________ Email: _____________________________________

Secondary Contact Name:

Phone: ____________________________ Email: _____________________________________

Name of person submitting form: ________________________________________________

Signature: _____________________________________________________________________

Date Form Submitted: __________

Advisor Name: _________________________Signature: ______________________________

Phone: _________________________________ Email: ________________________________

STUDENT ACT. USE ONLY

APPROVAL / DENIAL

BY: DATE:

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Sample Constitution

Article 1. NAME

The name of this club will be the XYZ club.

Article II. PURPOSE

Provide a general statement about the purpose and goals of the organization, as well as

the type and scope of the organization’s activities. This is also an appropriate place to mention

the organization’s affiliation with other groups, if any (if the group is affiliated with a national

org, like PTK). The purpose of XYZ shall be to foster leadership development through the

coordination of educational and awareness projects. XYZ will work toward its goals by:

A. Coordinating a regular series of roundtable discussions of student leaders

B. Meeting with University administrators to provide feedback on current leadership

development programs

C. Creating a mentorship program between first year students and graduating student

leaders

Article III. MEMBERSHIP

Describe the types of members and requirements for membership

1. Membership XYZ shall be open to any interested undergraduate student at

Germanna Community College. Members will be listed as either active or inactive.

Active members are those undergraduate students that have paid their membership fee

and are unable to attend meetings and have requested in writing to maintain their

membership.

2. GCC faculty/administrators may join the club as ‘associate members.’ Associate

members may not run for office and do not have voting rights.

Article IV. MEMBERSHIP FEES

1. All members must pay an annual membership of $5 due to the Club Treasurer no later

than September 15th.

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2. Members joining between Sept 15th and the end of the fall semester must pay the $5

membership fee to the Club Treasurer by the second meeting they attend.

3. Members joining in the Spring Semester must pay a $5 membership fee by the second

meeting they attend.

4. Members who are current on their payment shall be classified as ‘active’ members.

5. Only active members may participate in club activities

Article V. OFFICER ELECTION/IMPEACHMENT

1. All Club Officers shall be elected before Sept 15th and will serve a term from

September 15 to September 15th the following year.

2. Officer elections will consist of the following three step process:

A. Nominations will be held the meeting prior to the scheduled date of elections.

Any active club member may nominate a fellow club to any of the bluc officer

positions, with the exception of the President position. Only members holding a

current office or committee chair position shall be eligible to run for the

presidency of XYZ. The President must be nominated by a current officer of

chairperson. Nominations will only be accepted during the meeting prior to

elections. Candidates can be nominated for more than positions and they may

nominate themselves for a position if they are not nominated by another member.

B. Elections will consist of each candidate speaking for up to five minutes, followed

by up to three minutes of questions and answers from the club membership. Only

active members present at the meeting shall cast a vote, and only these votes shall

count toward the computation of the 50% +1 required margin for election to

office. The order of elections shall be as follows: President, Vice President,

Treasurer, and Secretary.

C. Run-Off Elections – In the event that no candidate receives at least 50% +1 of the

vote of the currently active members, a run-off election shall be held between the

two candidates receiving the most votes.

3. In the event that an officer is judged to be deficient in his/her duties (as decided by a

unanimous agreements of the three other club officers and advisor), he may be removed

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by a two-thirds vote of the club’s membership. The advisor shall oversee the

impeachment process to ensure a fair and speedy process.

Article VI. ADVISOR

1. The Club Officers shall unanimously agree upon and appoint an Advisor no later than

April 1 to serve a term from May 1 – April 30.

2. The Club Advisor must be a GCC faculty member or administrator.

3. The Advisor’s duties shall include:

a. Meeting with the club officers on a regular basis

b. Keeping aware of club issues and intentions

c. Meeting with Treasurer on a monthly basis to review account balances and

financial transactions.

d. Assisting with the implementation of an officer transition program.

4. The Advisor shall be an ex-officio member of the club, and as such, shall not have voting

rights.

Article VII. MEETINGS

1. The club shall meet at least once per month. A listing of meeting dates shall be

established by the Club Officers and shall be posted on the XYZ web site no later than

Sept. 1st.

2. Only active student members may vote at meetings

3. In the event that an emergency meeting of the club needs to be held, the President of the

club shall have the authority to call such meetings. All officers must agree in advance to

the emergency meeting and at least 24 hours’ notice must be provided to all active

members by sending out both an e-mail and a voicemail. Communication of emergency

meetings will be the responsibility of the Club Secretary.

Article VIII. FUNDS

Provide a general statement about the finances of the organization and how they are handled,

including what should happen to the organizations funds if the organization is dissolved.

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Detailed financial procedures including the amount and collection procedures for dues, if any,

should also be outlined here if no already appearing in the by-laws.

1. Members should use the current GCC purchasing process to buy anything with club

funds. All expenditures require an original, itemized receipt and a description of the

expense incurred.

2. Any expenditure in excess of $XXX must be approved by a majority of the Club

Officers.

3. All financial transactions of the Club will be managed through the GCC accounting

system.

Article IX. OFFICERS

In sections under this article; list the titles of offices to be established, qualifications for each

office includes the method, time, and process of selection, the term of office, and if you would

like, a minimum GPA . The duties, powers, and responsibilities of each officer as well as

procedures for removal from office and filling vacancies should also be outlined here if not

already appearing in bylaws.

At a minimum, each student organization is expected to designate one officer as the chief

students leader (usually titled ‘President’) and one officer authorized to deal with the organization’s finances (usually titled ‘Treasurer’). The titles of these positions may vary according to the needs of the organization.

1. The officers of XYZ shall be President, Vice-President, Treasurer, and Secretary.

The creation of additional officer positions (e.g. Co-President, Web Master, etc.) must

be approved by a two-thirds vote of the active membership and with the support of

the advisor

2. Only GCC students may serve as officers.

3. The duties of the President shall include:

a. Coordinating bi-weekly meetings of the club.

b. Chairing all meetings of the club.

c. Calling emergency meetings

d. Providing leadership to the club.

e. Working directly with the Club Advisor to ensure the club is operating within the

expectation of the University.

f. Acting as the chief spokesperson of the club.

g. Establishing an effective relationship with Student Activities and other College

administrative departments.

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4. The duties of the Vice-President shall include:

a. Keeping a record of all financial transactions

b. Appointing all committee chairs

c. Providing support for the development of club activities planned by the

committees.

d. Working with the Treasurer to establish budgets for committees which are

created.

5. The duties of the Treasurer shall include:

a. Keeping a record of all financial transactions

b. Meeting with the Advisor on a regular basis to review account balances and

financial transactions.

c. Preparing any and all budgets, financial budget requests/appeals, etc. and

present these to the SGA.

d. Working with the Vice-President to establish budgets for committees which

are created.

e. Maintaining detailed membership records, including the amount of dues

collected from each member.

f. Respond to audit requests from Financial Committee, meeting the deadlines of

the Finance Committee.

6. The duties of the Secretary shall be:

a. Keeping detailed minutes of all meetings.

b. Coordinating the press relations of the club, including, but not limited to:

Flyer/poster approval, and maintaining the club’s web page. c. Ensuring that all changes of officers are reported to the appropriate University

officials.

d. Working with the Vice-President to establish budgets for committees which

are created.

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ASSUMPTION OF THE RISK FORM – *SAMPLE*

I agree that as a participant in the ____________(club name)associated with Germanna

Community College (the “College”) scheduled for___________(date), I am responsible for my own behavior and well-being. I accept this condition of participation, and I acknowledge that I have been informed of the general nature of the risks involved in this activity,___________________________________________________________________________________________________________________________________________________________(list all risks).

I understand that in the event of accident or injury, personal judgment may be required by______________(club name) or College personnel regarding what actions should be taken on my behalf. Nevertheless, I acknowledge that the College and/or ________________(club name)personnel may not legally owe me a duty to take any action on my behalf. I also understand that it is my responsibility to secure personal health insurance in advance, if desired, and to take into account my personal health and physical condition.

I further agree to abide by any and all specific requests by the College and_____________(Club),

for my safety or the safety of others, as well as any and all of the College’s and _____________(Club) rules and policies applicable to all activities related to this program. I understand that the College reserves the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety or welfare of others.

In consideration for being permitted to participate in this program, and because I have agreed to assume the risks involved, I hereby agree that I am responsible for any resulting personal injury, damage to or loss of my property which may occur as a result of my participation or arising out of my participation in this program, unless any such personal injury, damage to or loss of my property is directly due to the negligence of the College. I understand that this Assumption of Risk form will remain in effect during any of my subsequent visits and program-related activities, unless a specific revocation of this document is filed in writing with___________________________(Club Advisor) at which time my visits to or participation in the program will cease.

I acknowledge that I have read and fully understand this document. I further acknowledge that I am

accepting these personal risks and conditions of my own free will.

____ I represent that I am 18 years of age or older and legally capable of entering into this agreement. ________________________________ ___________________ _________________

Participant’s Name Student ID No. Date

________________________________ ___________________@email.vccs.edu

Student Signature VCCS Email Address

________________________________ Cell Phone

In case an emergency situation arises, please contact ________________________________ Phone Number________________________________ ***Please see the back page if you, the student, is less than 18 years of age

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If participant is less than 18 years of age, the following section must be completed: ____ My child/ward is under 18 years of age and I am hereby providing permission for him/her to participate in this program, and I agree to be responsible for his/her behavior and safety during this event.

______________________________ ________________________________

Child’s Name Parent or Guardian’s Signature

_____________________________________________________ ________________

Address Date