Overnight Visit: Participant Agreement & Authorization Form

This form MUST be signed and submitted prior to moving any belongings into your host's room. This documentation is required to ensure we are prepared to serve all overnight participants to the best of our ability.

Conduct requirements for guests participating in an overnight recruiting visit sponsored by the Department of Athletics at Augustana College are also listed.

Relevant information may be shared with faculty, residential life staff, and dining services staff to prepare for your visit.

Prospective Student Information

Arrival Date

Departure Date

Hosting sport

Student email address

Student first name

Student preferred name (if different than first name)

Student last name

Student birthdate

Student mailing address

Country

Street

City

Region

Postal Code

Health Insurance Information

List the following information for the person who carries medical insurance on the registrant

First name

Last name

Employer

Employer address

Country

Street

City

Region

Postal Code

Insurance company

ID, group and plan numbers

Please provide any information about the participant's health you think is important for our staff to be aware of during the overnight visit (ex. food or other allergies).

Upload a copy of the insurance card

Emergency Contact Information

First name

Last name

Cell phone number

Relation to participant

Would you like to provide a second emergency contact?

Yes

First name

Last name

Cell phone number

Relation to participant

Will you be parking a vehicle on campus overnight during your visit?

Yes

Vehicle Information

Make

Model

License plate #

Section 1: Social Conduct Agreement

I understand that as guest of the Augustana College Department of Athletics, I am expected to abide by all campus, local, state, and federal laws. I understand that ignorance of these provisions is not a legitimate defense and that I may be subject to prosecution by civil, criminal, or college processes if found in violation.

Prohibited Conduct (Augustana Code of Social Conduct Excerpts):

Theft & Property Damage: Theft or wrongful possession of property not one's own; vandalism or damage to property (including student rooms, common areas, classrooms, and residential/hotel/dormitory facilities).
Substances: Purchase, possession, use, sale, or distribution of alcohol or illegal drugs.
Weapons & Explosives: Possession or use of fireworks, explosives, incendiaries, dangerous chemicals, or weapons (including firearms, pellet guns, air rifles, bows/arrows, and knives).
Fire Safety: Careless/malicious use of fire; tampering with fire-fighting equipment; or intentional false reporting of a fire/bomb.
Facilities: Unauthorized entry or use of Augustana College or program facilities (owned, leased, or rented), including living facilities, classrooms, and study rooms.
Harm & Harassment: Conduct causing/intended to cause personal injury or emotional threat to others; disorderly/indecent conduct; conduct ridiculing or deliberately offending any persons culture or religion; racial discrimination, sexual discrimination, or sexual harassment toward any group member, staff, or resident.

*Note on Possession: The presence of articles may be interpreted as actual possession. Students apprehended in locations where drugs, alcohol, fireworks, weapons, or other misconduct is evident will normally be considered in violation of this code, even if prohibited items are not on their person at the time.

Expectations & Discretionary Time:

Chaperones will not use personal vehicles to transport visitors. Any needed transportation will be provided by the Department of Athletics.
I understand the Department of Athletics may communicate additional rules that I must abide by.
I am expected to make decisions that support the plans my coach has laid out during discretionary free time. Attending off-campus parties, consuming alcohol, and engaging in disruptive or offensive behavior is strictly prohibited.
If I place myself in dangerous situations, I do so against the coach's intentions. I understand that my parent(s)/guardian may be called and I may be asked to return home early at my own/parental expense.

Section 2: Waiver and Release of All Claims

Please read carefully. By signing, you expressly assume risk and legal liability, waiving and releasing all claims for injuries, damages, or loss sustained from activities connected with the Overnight Visit.

Voluntary Participation: I wish to participate in the Overnight Visit freely and am not being forced to take part.
Assumption of Risk: I understand that participation involves inherent, sometimes unpredictable risks (including health/weather conditions, serious physical injury, illness/disease exposure, emotional distress, property loss, or criminal acts by others). Even monitoring by Augustana College cannot guarantee my safety. I assume all risks and responsibilities surrounding my participation.
Waiver, Release, & Indemnification: I agree to release, indemnify, and hold harmless Augustana College, its officers, directors, trustees, agents, and employees ("Releasees") from any and all liabilities, claims, or demands for personal injury, property damage, or loss sustained as a result of my participation, even if resulting from negligence (excluding gross negligence). I understand I am giving up my legal right to sue for damages.
Insurance Required: I certify that I carry accident and medical insurance, which is required for all overnight participants.
Supervision & Valuables: I understand that not all activities will be supervised. Augustana College is not responsible for injuries suffered if I separate from my host, team, or coach. I am solely responsible for safeguarding my valuables (money, jewelry, property).

Section 3: Authorizations & Legal

Medical Treatment Authorization: Augustana College is authorized (but not obligated) to take any actions it considers warranted regarding my health and safety under the circumstances, including notifying my parents/guardian. I agree to reimburse Augustana College for all related medical expenses and release them from liability regarding authorized treatments.
Photo Release: I grant Augustana College permission to photograph me and use those images in printed or electronic media without prior notification, viewing rights, or compensation.
Binding Effect & Forum: This agreement binds my family, heirs, assigns, and personal representatives. It is construed under the laws of the State of Illinois, which will be the sole forum for any legal proceedings. If any part of this agreement is deemed invalid by a court, the remaining portions remain in full force.

Section 4: Signature & Acknowledgment

By signing below, I acknowledge that I have read, understood, and agree to abide by all the terms, rules, and waivers outlined in this combined document.

Participant name (printed)

Participant signature

Click to Sign...

Date

Is the participant less than 18 years old?

Yes

A parent or legal guardian must also sign to acknowledge and accept the terms of this entire agreement, including
the Social Conduct Agreement, Waiver, and Medical Authorization.

Parent/guardian name (printed)

Parent/guardian signature

Click to Sign...

Date