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AGREEMENT FOR PARTICIPATION IN THE TRIO PRE-COLLEGE PROGRAM.

ACKNOWLEDGEMENT AND ASSUMPTION OF RISK / RELEASE OF CLAIMS


Agreement for Minor's Participation in Enrichment Activity

Acknowledgement and Assumption of Risk, Agreement to Release All Claims and Agreement to Indemnify the University of Alaska Anchorage. 

1. Inherent Risks - I understand and acknowledge that there are known, unknown, and unanticipated risks and dangers that are qualities of these activities that cannot be eliminated. These are often called “inherent risks” and will be referred to this way in this document.

Travel: risks related to transit to or from the Activity locations including, but not limited to, travel by bus, boat, raft, van, and private or rented auto; including travel in unpredictable or extreme weather conditions that affect road or air safety; activities supplemental to the Activity, such as walking or hiking to and from sites of interest; use or operation, by me or others, of equipment and vehicles in the condition in which they are found; exposure to inclement weather including, but not limited to rain, sun, wind, and extremes of cold or heat; contact with dangerous and environmental or biological hazards; use of facilities, roads, sidewalks, parking lots, and trails that may or may not be properly maintained; exposure to contaminated food and untreated water; risk related to the rendering or receipt of emergency first aid, or other emergency treatment, and transport in medical emergencies; accident or illness in locations without access to appropriate medical facilities or supplies; potential exposure to COVID-19 or other illnesses; and other unknown and unanticipated activities and risks.

2. Possible Harms - I understand that these “inherent risks” can result in “harms,” which in this document means damage to property; permanent or temporary physical, emotional, and mental injury to myself or others; and, death or disability of myself or others.

3. Investigate Risks - I agree that it is my responsibility to understand the risks in my participation in these activities. It is my responsibility to investigate the risks if I do not fully understand these risks.

4. Assumption of Risk - After considering the “inherent risks” and “harms” that may result, I voluntarily assume all “inherent risks” that I may encounter during participation in or transportation to, from or as a part of these activities, and I agree to be financially responsible for any “harms” that result.

5. Release – In consideration of my voluntary participation in these activities despite the inherent risks and harms associated with them, I release and forever discharge the University of Alaska, its Board of Regents, officers, agents, employees, and volunteers (hereafter “University”), from all liability and claims of any kind for any “harms” to me arising out of the activities that are listed in Paragraph 1 above. This includes claims for loss, expense, damages, punitive damages or attorney fees.

6. Other Providers - I understand that my assumption of risk and release and of the University apply regardless of whether this activity is operated, sponsored, or hosted in whole or in part by the University of Alaska or a third party.

7. Accommodations - I certify that I am in good health and I know of no medical reason why I am not able to participate. If I have a disability, food or drug allergy, dietary requirements or any other condition requiring accommodation, I will contact the activity director at least fourteen (14) days prior to the start of the activity.

8. Consent to Care - I consent to first aid, emergency medical care, and if necessary admission to a hospital for care and treatment for injuries or illness anytime during this activity.

9. Financial Responsibility - I understand that I am responsible for obtaining insurance and for any expenses that arise out of medical care. Upon my request and at my expense accident insurance may be available to me through the University.

10. Compliance with Rules - I agree that I will abide by all University policies, regulations, and procedures and by all local, state and federal laws. If I fail to abide by these rules and laws, that may be a basis for denying or ending my participation in this activity.

11. Others Affected - I intend that this Agreement is and will be binding on my family, estate, heirs, successors, assigns, insurers, medical providers and personal representatives.

Student Commitment

I agree to:

1.) Maintain a GPA of 2.5 or higher

2.) Actively participate in meetings and events with TRIO staff

3.) Display behaviors and attitudes that are respectful, appropriate and bring honor to my parent/guardians, my school, the TRIO Program, and myself

4.) Communicate clearly and regularly with TRIO staff through in person-meeting, email, text, Remind or other means

Parent/Guardian Commitment

I agree to:

1.) Fully support and facilitate my child's involvement in the TRIO Program

2.) Attend TRIO activities involving parents/guardians during the year

3.) Communicate pertinent information regarding student concerns of enrollment, academic success, and overall wellness

By my signature, I agree and represent that: I have entered into this Agreement on the basis of my own assessment of the risks involved and not in reliance upon representations of the University, its employees, officers or agents; I understand that I have the right to consult an attorney of my choice before signing this Agreement; I further understand that this Agreement contains our entire agreement, and that it cannot be modified except in a writing signed by me and the University; Alaska law applies to this Agreement and any dispute will be resolved in the state court located in Alaska; If any part of this Agreement is found to be invalid or unenforceable for any reasons, the balance of the Agreement remains valid and enforceable; This a legally binding agreement designed to protect the “University” from claims that could be brought by myself or anyone else because of “harms” to me.

Today's Date: May 23, 2026


First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 19 years of age or older
First Participant's Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Second Participant's Signature*
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Third Participant's Signature*
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Insurance Information (N/A if not applicable)
Insurance Carrier
Insurance Policy Number
Medical Questionnaire

Do you have any food or other known allergies? If so, please list: *
Does your child take any prescription medications that need to be taken during TRIO events? (usually between 8am-4pm). *
No
Yes

If your child takes prescription medications that will need to be taken during TRIO events, please let us know the type of medication, dosage/frequency and purpose:

I, parent/guardian) agree that my child can self-administer their own prescription medications and approve them to do so. In addition, I have reviewed the list of over-the-counter medications (below) for potential interactions with the child's prescription regimen and approve their use when administered by an adult staff member according to package directions.*
Yes
N/A
Over the counter (first-aid type) medications: Please review the list and check the medications that you want given to your child in case of minor illness or injury.
Tylenol/Acetaminophen
Dramamine (motion sickness medicine)
Ibuprofen
Day-quil (or other cold and flu medicine)
Tums (or other antacid)
Benadryl (or other antihistamine tablets)
Sunscreen 30 SPF (or higher)
I (parent/guardian name) give the University of Alaska Anchorage TRIO Pre-College Program staff permission to administer the items checked above while my child participates in the University of Alaska Anchorage TRIO Pre-College events.*
Yes
N/A


Parent(s) or court-appointed legal guardian(s) must sign for any participating minor 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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 19 years of age or older
Parent or Guardian's Information
I agree that University personnel may photograph, videotape or record me in connection with this activity. I agree that the University will be the owner of all images and recordings and own all copyright in the images and recordings. The University may use these images and recordings for advertising or other media releases.*
Yes
No
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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