FIELD TRIP FORM:

(Duplicate on Campus Letterhead)

Field Trip Considerations
University of Wisconsin - (Campus Name)

Course Name ____________________________  Course Number ______________

1.    Go and return with faculty & participants of the field trip unless arranged in writing
       before departure.

2.    Communication with sponsors/chaperones/faculty if you are deviating from the
       established daily schedule prior to the day's activities.

3.    For your own safety, travel in pairs or as a group.

4.    The cost of the trip is _____________ and includes (specify):

5.    Sponsors are not responsible for (specify - meals, gratuities, overnight accommodations,
       transportation, etc.):

6.    If state vehicles are used on the trip, they should only be used for transportation relating
       to the course structure and true purpose of the trip.

7.    On field trips that involve more than one day, a hold harmless agreement should be signed
       by each participant.

Hold Harmless Agreement:

I,        (Student's Name)               , do hereby agree to hold harmless and/indemnify the
State of Wisconsin, the Board of Regents of the University of Wisconsin System, and the
University of Wisconsin -        (campus)                   , their officers, agents, and employees
from any and all liability, loss, damages, costs or expenses which are sustained, incurred,
or required arising out of the trip to           (destination)            on                (date)           .
I certify that I am over 18 years of age.  If not, the signature of my parents or guardian
appears below.
 

                                                                        
Name (print)                                                    Signature (student/guardian)                Date

                                                       
Address                                                          City/State