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Deferment Request for 21-Day Trip

It is expected that all incoming freshmen will complete the 21-day trip prior to starting classes in the fall. However, we understand that there might be a legitimate need to defer the trip until the following year. Because the 21-day trip is a requirement of the academic curriculum, the only person that can approve a deferment is the Academic Dean. To request a deferment of the 21-day trip, please complete this form.

If you want to defer both the 21-day trip and your attendance at WCC until next fall, please contact your Admissions Counselor.

By signing this form, you acknowledge that the information you provided is true and correct.  If additional information or documentation is requested, you agree to respond and provide it within a reasonable time.  You also acknowledge that the deferment request is not approved until you receive a decision from the Academic Dean.

If the deferment request is approved, you understand that you are expected to participate in the 21-day trip prior to the start of your sophomore year.

In order to participate in the other outdoor trips and the winter trip during your freshman year, we need to receive a completed Physical Examination Form that has an endorsement from a health care provider that you are physically able to complete the trip(s).  If you were not able to participate in the 21-day trip due to illness or injury, a letter from your treating health care provider stating that your illness or injury has resolved and you are well enough to participate is required.


Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Reason for Deferment Request
Click to customize checkboxes *
Injury
Serious Illness
Family event that requires my attendance
Other
Please explain in detail the need to defer the 21-day trip. In the event of serious illness or injury, please provide information about your diagnosis, the treatment you are receiving, the prognosis and anticipated timeline for recovery. Please scan/email supporting documentation for this request to jwestman@wyomingcatholic.edu.
Please provide your contact information below. This should be a phone number where you can easily be reached or an email that you check frequently. You may also include the contact information for a parent or guardian who has knowledge of the situation and you are comfortable with our contacting them as well.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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