Pre-College Summer Liability Waiver Form

The University of Connecticut Pre-College Summer at UConn Program: Liability Waiver Form

  • 2017 Participation Agreement

    Attendance and Participation: Participants are expected to attend all Program classes and activities of their choosing. They are expected to be punctual and to participate in a respectful matter. If for any reason the participant is unable to attend or arrive on time to any class or activity, the participant must contact a staff member (in most cases, their assigned Resident Manager, or one of the Hall Coordinators). If a participant is absent and unaccounted for, we will contact the participant using the contact information provided. If we are unable to reach the participant after 30 minutes, we will contact the participant’s parent or guardian according to the contact information provided and the program director will additionally be notified. Behavior: Participants must abide by all applicable federal, state, local, and UConn laws, policies, codes and procedures as well as all Pre-College Summer at UConn Program Rules and Regulations. Any participant who endangers his or her own health or safety or the health or safety of another student, staff member, or faculty member will be subject to disciplinary action. Consumption, possession, or being in the presence of alcohol or illegal drugs is grounds for immediate dismissal from the program, as is possession or use of drug paraphernalia, firearms, knives, other weapons, or fireworks. Participants must show respect for the rights and safety of others in the community and must not engage in any form of harassment, hazing, intimidation or bullying. Bullying means any behavior, whether in-person, groups, or through other mediums (e.g., hand written notes, phone calls, texting, any social media platform, etc.), intended to offend or intimidate another person (student or staff). Participants who engage in any form of bullying, harassment, hazing, or intimidation will automatically be dismissed from the program. Supervision: The Program is a creative academic program for mature, self-motivated rising high-school juniors and seniors. The Program is not a summer camp and does not provide round-the-clock supervision. Supervision is provided during the following scheduled activities: classes, workshops, craft sessions, Q&A panels, studio courses, field trips and meals. During free time, and the evening activities in the residential halls, participants may choose whether to engage with the group or spend their time independently. At all times, participants will have access to a program staff member as needed. The ability of participants to follow program, University, state and federal laws, and to act independently in a supportive college setting is required. Financial Responsibility: The parents or legal guardians of participants in the Program are financially responsible for any damage or loss suffered by UConn caused by their son, daughter, or ward. Medication: An onsite nurse will not be present to administer medication to your child. It is the participant’s responsibility to secure and self-administer any necessary medications. A small refrigerator kept in the staff office of the residence hall will be available for participant use for medication only. If students need to store medication in the refrigerator, they will need to ask a staff member, as this room is kept under lock and key. Car Policy: Use of a car during the program is not allowed. Under no circumstance is a participant allowed to ride in any vehicle unless approved by Program staff for Program-related activities. Cell Phone Policy: The residence halls are not equipped with telephones; therefore it is highly recommended that participants bring a cell phone for ease of contact according to the attendance and participation agreement. Tobacco Policy: Tobacco use is prohibited. Minors found in possession of tobacco will be subject to immediate dismissal from the Program. UConn Computer/Technology Policy: The use of University owned computer resources and technology for purposes other than academic research and instruction is prohibit.
  • Residence Hall Regulations

    Participants in residence (“Residents”) must abide by all applicable regulations. Residents who violate any of these regulations may be subject to dismissal from the residence hall and the Program. If dismissal is deemed necessary, the Residents will be sent home at the expense of his or her parents or legal guardian(s). No refunds will be issued. Community Living Standards. All Residents are expected to be respectful and responsible members of the communities within UConn residence hall. Participants are expected to refrain from actions that prevent individuals from having a safe and respectful community living experience. Health and Safety Standards. Any activity deemed to be a threat to the health and safety of students is strictly prohibited. Basic health standards are expected around sanitary conditions, hygiene, and appropriate use of bathrooms and common areas. It is an expectation that participants will keep kitchen areas, bathrooms, hallways, and their rooms clean. Security Regulations. The maintenance of a safe and secure residence hall environment is the responsibility of each Resident. All participant are responsible for adhering to the stated policies regarding residence hall security, guests, entrance/exit doors, and maximum room capacity. Guests and Visitation. No guests or visitors outside of the program are permitted in the residence halls. Overnight Leave. Overnight visits off-campus during the program are prohibited. Curfew Policy. Students must be on their respective floors by 10 PM and in their assigned rooms for the night by 10:30 PM. Student’s access cards to the building will be rendered inactive after 11 PM. A $100 lockout fee will be charged to the credit card on file and the participant’s parent/guardian will be called. A second missed curfew will result in dismissal from the Program. Noise Policy. Residents must comply with requests to reduce excessive noise. At no time should any amplified sound be directed out of residents' windows. Disorderly Conduct. Disorderly conduct such as excessive noise, stereos, radios, musical instruments or sound amplification equipment, rowdiness, water fights in residence halls or other loud and disruptive action will not be tolerated. Furniture Policy. Each residence hall room is furnished with UConn furnishings, which must remain in the Residents’ rooms at all times. In addition, lounge furnishings must remain in public areas at all times. Residents may be held financially responsible for costs associated with replacing missing or damaged furniture and/or removing unauthorized furniture from their rooms. Window Screen Policy. Window screens must remain on windows at all times. Candle Policy. Candles, lit or unlit, are not permitted in participant rooms. Recreational use of candles is prohibited in all areas of the residence halls. Incense Policy. Incense, lit or unlit, is not allowed in the residence halls for fire safety reasons. Pet Policy. UConn prohibits pets in the residence halls. Alcohol, Drugs, Firearms, etc. Policy. Consumption, possession, or being in the presence of alcohol or illegal drugs is grounds for immediate dismissal, as is possession or use of drug paraphernalia, firearms, knives, other weapons, or fireworks. Health & Safety Inspections. UConn reserves the right to enter residence hall rooms without the consent of the occupant in order to provide for the general well-being and protections of the community, its members and property. Program students are expected to keep their room clean and discard of any trash in their room in the provided trash rooms located on their floor. Residential staff may conduct inspections to seek out and correct potentially dangerous situations before they cause damage or harm. If in the course of such an inspection other violations are observed, they may be reported. Key Card Policy. All residence hall access cards and keys must be returned at checkout from the residence hall. There is a $100 fee for each lost key and a $25 fee for each lost access card.
  • Disciplinary Sanction

    Failure to abide by the Program and Residence Hall rules and regulations, required laws, policies, codes, or procedures or failure to respect the authority of Program staff members in their enforcement, may result in sanctions including, but not limited to: • Parental Contact • Limitations on activities • Restitution for property damage • Dismissal from the Program. If dismissal is deemed necessary, the participant will be sent home at the expense of his or her parent(s) or legal guardian(s). No refunds will be issued. Note: For additional information regarding UConn polices and codes, please see UConn's Community Standards page:

  • To: The University of Connecticut ("University") I fully recognize that there are dangers and risks to which I may be exposed be participating in the Pre-College Summer at UConn Program ("Program")
  • Description of Program Activities ("Activities")

    I understand and acknowledge that my participation will consist of attending session(s) offered as part of the Program by the University during the summer of 2017. Such sessions may include workshops, seminars, debates organized as part of the program, and performing laboratory research under the overall supervision of a member of the University’s faculty. I further understand that if conducting lab research, I will be exposed to an environment where hazardous chemicals are used and stored. Additionally, the laboratory environment also contains equipment that, if used improperly, could cause injury. Examples of equipment include but are not limited to lasers, open flame burners, high pressure non-combustible gas equipment, pressurized solvent vessels, glassware and other equipment. Please refer to the lab safety policies and procedures provided in the lab sections. I also understand that the program does not provide round-the-clock supervision. Supervision will only be provided during the following scheduled activities: workshops, craft sessions, Q&A’s, studio courses, field trips, and meals. Program accommodations do not include a phone and I am encourage to bring a fully functional cell phone.
  • Risks and Dangers Associated with Participation

    The following are examples of specific, significant, non-obvious dangers and risks associated with participating in the Program: loss or damage to property, physical injury or illness including, but not limited to, bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability.
  • Release

    I understand that the University does not require me to participate in this Program, but I choose to do so, despite the possible dangers and risks and despite this Release. I therefore agree, in consideration of and return for the services, facilities, and other assistance provided to me by the University in this Program, to RELEASE the University (and its Board of Trustees, officers, employees, and agents) from any and all liability, claims and actions that may arise from injury or harm to me, from my death or from the loss or damage to my property in connection with my participation in this Program. I understand that this RELEASE covers liability, claims and actions caused entirely or in part by any acts or failures to act of the University (or its Trustees, employees, or agents), including but not limited to negligence, mistake, or failure to supervise by the University. Additionally, I agree to indemnify and hold harmless the State of Connecticut, its officers and employees, and each of them, of and from any and all loss, damage, cost, expense, claims, liability, and causes of action whatsoever arising out of the any Program provided by at the University of Connecticut. I recognize that this RELEASE means I am giving up, among other things, rights to sue the University, its Trustees, employees, and agents for injuries, damages, or losses I may incur. I also understand that this Release binds my heirs, executors, administrators, and assigns, as well as myself.
  • Parent/Guardian:

    By checking the box below, I attest that I am the parent and/or legal guardian of the applicant, that I am authorized to act on behalf of and legally bind the applicant and that the signature or agreement of another parent/guardian is not required. I have also read the Liability Release Form and consent to the above statements. NOTE: THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE CHECKING THE BOX BELOW.

  • the University of Connecticut ("University") and its agents to: -Record any likeness of myself on videotape, film, audiotape, film, photograph or any other medium -Use, reproduce, modify, distribute, and publicly exhibit such recordings, in whole or in part, without restrictions or limitation for marketing or any other purposes that the University deems appropriate.
  • to the use of my name, voice, and biographical material in connection with such recordings. I release the University, its Trustees, officers, employees and agents from any liability whatsoever based on or related to its use of any photographs, portraits, or other likenesses of me in any medium and the use of my name, voice, or biographical information, including without limitation violation of rights of privacy, publicity, libel, defamation or any similar right, for the purposes described above. I further release the University, its Trustees, officers, employees and agents from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the recording process, or any unintentional misspellings or inaccuracies. I waive any right I may have to inspect or approve any finished photographs, portraits, or other likenesses of me.

  • To be completed by a parent/guardian if participant is under age 18

    In submitting this form I hereby certify that, to the best of my knowledge, the medical information provided in the Health History Form herein is true and complete. The Health History Form can be downloaded and completed at In case of medical emergency, I hereby give the University of Connecticut permission to secure proper treatment for, and to order injection or minor surgery for my child/ward on my behalf. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the UConn in the exercise of its best judgment upon the advice of any such medical or emergency personnel.