Student Agreement and Medical ReleaseStudent Agreement and Medical Release • March 26th, 2013
Student Name:Last: First: Student I.D. # Address: City: Zip: Home Phone:( ) Cell Phone:( ) E-mail:@student.mtsac.ed@u Class Name: Class Reference # Faculty/Staff/Advisor Name: Telephone #( ) Department: Semester/Session: 🞎 Fall 🞎 Winter🞎 Spring Year:🞎 Summer Travel Destination(s) and Date(s): General Description of Activities:
Student: Agreement and Medical Release For Field Trip and ExcursionsStudent Agreement and Medical Release • January 20th, 2017
Student: Agreement and Medical Release For Field Trip and ExcursionsStudent Agreement and Medical Release • April 17th, 2023
Waiver: I understand that I hold Barstow Community College District (herein referred to as “District”) its agents and employees harmless from any and all liability or claims, which may arise out of or in connection with my participation in this activity. (Reference: Title 5 Section 55220) I fully understand that participants are to abide by all rules and regulations governing conduct during the trip. Any violations of these rules and regulations may result in that individual being sent home at his/her expense.
Student: Agreement and Medical Release For Field Trip and ExcursionsStudent Agreement and Medical Release • January 20th, 2017
Student Name Last: First: Student I.D. # Address: City / State: Zip: Home Phone: ( ) Cell Phone: ( ) Email: Faculty/Staff/Advisor Name: Class Name: Travel Date(s) / Time: Travel Destination(s): General Description of Activities:
Student Agreement and Medical ReleaseStudent Agreement and Medical Release • March 26th, 2013
Student Name: Student I.D. #Last: First: Address: City: Zip: Home Phone: Cell Phone: E-mail:( ) ( ) @ Class Name: Class Reference # Faculty/Staff/Advisor Telephone #Lynn Matthiesen ( 909 ) 274-4682 Department: Semester/Session: ¨ Fall ¨ Winter Year:Bridge Program #700 & Minority Male Initiative (MMI), Student Se ¨ Spring ¨ Summer Travel Destination(s) and Date(s):Pantages Theatre, Los Angeles, Thursday, October 14, 2021 Depart 5:30 PM Arrive 11:00 PM General Description of Activities:Students from Bridge Program and Minority Male Initiative (MMI) will attend Hamilton play at the Pantages Theater.
Student Agreement and Medical ReleaseStudent Agreement and Medical Release • March 26th, 2013
Student Name:Last: First: Student I.D. # Address: City: Zip: Home Phone:( ) Cell Phone:( ) E-mail:@ Class Name: Class Reference # Faculty/Staff/AdvisorJolene Chong Telephone #( 909 ) 274-4381 Department:El Centro, Student Services Semester/Session: 🞎 Fall 🞎 Winter🞎 Spring Year:🞎 Summer Travel Destination(s) and Date(s):Riverside Art Museum, Riverside. Wednesday, September 14, 2022Meet at 11:30 for lunch, Depart at 12:45 pm, Arrive back to Mt. SAC at 5:00 PM General Description of Activities:Students from El Centro will attend The Cheech Marin Center for Chicano Art and Culture at the Riverside Art Museum
Student Agreement and Medical ReleaseStudent Agreement and Medical Release • March 26th, 2013
Student Name:Last: First: Student I.D. # Address: City: Zip: Home Phone: Cell Phone:( ) ( ) E-mail:@ Class Name: Class Reference # Faculty/Staff/AdvisorLynn Matthiesen Telephone #( 909 ) 274-4682 Department:Bridge and El Centro Programs #700 Student Services Semester/Session: 🞎 Fall 🞎 Winter🞎 Spring Year:🞎 Summer Travel Destination(s) and Date(s):The Lighthouse, Hollywood, Friday, April 15, 2022 Check in by 11:30 AM, Depart 12:00 PM, Arrive 3:00 PM General Description of Activities:Students from the Bridge Program will attend Immersive Frida Kahlo at the Lighthouse in Hollywood.
