Student Trip Registration Form - Georgia

STUDENT TRIP REGISTRATION FORM

Please complete every line, using NA where not applicable. Be sure to complete all pages and sign where indicated.

Name: Phone:

Address:

KSU # : Date of Birth:

Trip:

Trip Date (s):

Trip semester: Fall Spring Summer

Address:

Phone(s): Relationship:

Have you signed the Waiver of Liability and Covenant Not to Sue? Yes No

Have you signed the Alcohol Policy Form? Yes No

List any allergies that you have (including food or drug allergies):

List any medications you are currently taking:

I agree that as a participant in this school sponsored trip, I will be responsible for my own actions at all times.

Signed Dated

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Student Trip Registration Form 06-07