EXploring College Emerging Leaders (EXCEL) Application

Contracts

Personal Respect Contract

Respect of self is the first aspect of giving respect to others. We are working to inspire the youth of the EXCEL program to develop a mature work ethic. We believe work ethic begins with showing respect to self and those that you work with. Behaviors that we would like to see exhibited are the following:

1. BEING ON TIME TO ALL ACTIVITIES: This is the most important. (An example of being disrespectful is being late for any of the scheduled activities that have been planned.)

2. When in workshops, show respect by being attentive and listening with interest. (An example of disrespect would be laying your head down on the desk and sleeping or passing notes to each other.)

3. No cell phones or electronics will be allowed during labs or other class activities. If caught using while in class, they will be taken away and kept by the counselors until after class.

4. Being professional is being refreshed and ready for the work day. You need your sleep, and lights out means time to sleep. [Examples of being disrespectful would be talking after lights out or sneaking out of your room. If caught sneaking out of your room, you will be sent home the next day and a program staff member will call the parent or guardian at the time of being caught, no matter what time (I.E. if caught at 2:00 a.m., a call will be made at that time.)]

5. Being respectful of fellow participants. This includes no put-downs, no rough horse play, and no foul language.

6. Following directions. WSU college students will be with participants throughout the day, ensuring participation and safety of all. We expect you to comply with their instructions, so the program will be enjoyable for everyone.

7. Being respectful of chaperones in the hotel. We have male and female chaperones, who will be staying at the hotel with the students. We expect you to comply with their instructions and respect the rules of the hotel and other hotel guests.

8. USE, POSSESSION, OR DISTRIBUTION OF WEAPONS, ALCOHOL, DRUGS, TOBACCO, OR ANY OTHER ILLEGAL PRODUCT IS PROHIBITED. YOU WILL BE REPORTED TO LAW ENFORCEMENT AND BE SENT HOME IMMEDIATELY.

Yes, I agree to the statement above

No, I do not agree to the statement above

Parent Authorizations:
Assumption of Risk
I understand that there are risks in participating in lab activities, classroom workshops at the EXCEL Program activities at Washington State University (WSU).

In consideration for and as a condition of being allowed to participate in this voluntary activity, I agree to take full responsibility for any and all risks that exist, including the risk of death or injury to the participant or loss or damage to my property. I understand that there may be risks that WSU cannot predict or foresee, and I also assume full responsibility for those risks.

Risks in participating in the EXCEL Program activities including lab activities, classroom workshops and recreational activities include, but are not limited to: temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, orthopedic damage, head, neck or spinal injuries, loss or use of arms and/or legs, eye damage, disfigurement, burns, drowning or death. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of traveling to or from the EXCEL Program activities that cannot be specifically listed. Further, I recognize that the actions of other participants in the activity may cause harm or loss to the participant or my property. I also understand I may be exposed to various infectious pathogens known to cause illness and disease in humans, including, but not limited to SARS-CoV-2. I am aware SARS-CoV-2, which causes COVID-19, is circulating within the community, and within shared space settings. I voluntarily and freely agree to knowing the risks of contracting COVID-19 and other respiratory illnesses during this experience. Such risks include, but are not limited to, respiratory failure, organ failure, death, aggravation of existing health conditions, stress, social-stigmatization, and/or spreading the infection to others.

Release of Liability

I release the state of Washington, the Regents of WSU, WSU, any subdivision or unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses, that I may sustain as a result of my participation in the above event. My participation includes, but is not limited to, travel to and from the event in a private or public vehicle, and any activity connected with the event itself, and while using state equipment or facilities for the event whether on or off WSU property.

I have carefully read this document, understand its contents, and am fully informed about this program and its events and circumstances and being apprised of the risks inherent in the activity, assume the risk of participation and release WSU from liability as set forth here in. I am aware that this document is a contract with WSU. I, or my parents/legal guardians if I am under the age of eighteen, sign it freely and voluntarily.

Parent Authorizations:
Assumption of Risk
I understand that there are risks in participating in lab activities, classroom workshops at the EXCEL Program activities at Washington State University (WSU).

In consideration for and as a condition of being allowed to participate in this voluntary activity, I agree to take full responsibility for any and all risks that exist, including the risk of death or injury to the participant or loss or damage to my property. I understand that there may be risks that WSU cannot predict or foresee, and I also assume full responsibility for those risks.

Risks in participating in the EXCEL Program activities including lab activities, classroom workshops and recreational activities include, but are not limited to: temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, orthopedic damage, head, neck or spinal injuries, loss or use of arms and/or legs, eye damage, disfigurement, burns, drowning or death. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of traveling to or from the EXCEL Program activities that cannot be specifically listed. Further, I recognize that the actions of other participants in the activity may cause harm or loss to the participant or my property. I also understand I may be exposed to various infectious pathogens known to cause illness and disease in humans, including, but not limited to SARS-CoV-2. I am aware SARS-CoV-2, which causes COVID-19, is circulating within the community, and within shared space settings. I voluntarily and freely agree to knowing the risks of contracting COVID-19 and other respiratory illnesses during this experience. Such risks include, but are not limited to, respiratory failure, organ failure, death, aggravation of existing health conditions, stress, social-stigmatization, and/or spreading the infection to others.

Release of Liability

I release the state of Washington, the Regents of WSU, WSU, any subdivision or unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses, that I may sustain as a result of my participation in the above event. My participation includes, but is not limited to, travel to and from the event in a private or public vehicle, and any activity connected with the event itself, and while using state equipment or facilities for the event whether on or off WSU property.

I have carefully read this document, understand its contents, and am fully informed about this program and its events and circumstances and being apprised of the risks inherent in the activity, assume the risk of participation and release WSU from liability as set forth here in. I am aware that this document is a contract with WSU. I, or my parents/legal guardians if I am under the age of eighteen, sign it freely and voluntarily.

Yes, I agree to the statements above

No, I do not agree to the statements above

Student: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of student's electronic signature

Parent/legal guardian: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of parent/legal guardian's electronic signature

In Case of Medical Emergency
In an emergency requiring medical attention or a situation reasonably believed to be an emergency by Washington State University (WSU) authorized agents including event staff; I authorize WSU and its authorized agents to obtain emergency medical care for my child. I will be responsible for any expenses incurred in so doing including but not limited to care by health care professionals, hospital care, and ambulance or other services. In addition, the health care provider has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

NOTE: Minors may consent to certain services in Washington.

I hold harmless and agree to indemnify Washington State University, its authorized agents and employees and the event staff from decisions to seek emergency treatment.

Yes, I agree to the statement above

No, I do not agree to the statement above

Parent/legal guardian: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of parent/legal guardian's electronic signature

Images and Recordings Consent
We hereby grant permission to Washington State University (WSU) to be photographed or otherwise have images or voice recordings made (including but not limited to digital photographs, video or digital moving images and/or voice recordings), for WSU publication or promotional purposes in any medium (including but not limited to print media, newspaper, television, video, motion picture, or Web site on the Internet).
I additionally consent to the use of the participant’s name and/or interview comments in connection with WSU publication or promotional purposes in print media, newspaper, television, video, motion picture, or Web site on the Internet.

We understand that consent to use the participant’s likeness or voice recordings is not a condition of participating in the activity and that consent can be refused without any impact in the ability to fully participate in the program.

No inducements or promises beyond our acceptance of an opportunity to promote WSU and its programs have been given to the persons signing below.

Any other use of images and/or recordings, my name, and/or interview comments requires advance permission.

We understand that we can revoke this consent at any time upon notice to WSU, at which time either or both of us will sign a copy of the denial (below) for use of images or voice recordings.

Yes, I agree to the statement above

No, I do not agree to the statement above

Parent/legal guardian: Please type your full legal name below as an electronic signature. By providing my electronic signature below, I certify that my responses are true and correct to the best of my knowledge.

Date of electronic signature