Registration Form

Please fill out for each person in your group.

*Make sure you fill each area in. Where you have no answer please enter ‘NA’ before submitting.

 

Trip Registration

Personal Infomation

Special Needs

Room Arrangements

First Last – 123-456-7890

Emergency Contact Information

First & Last
123-456-7890

Dixie State University Art Program Travel Registration and Agreement

DSU policy requires that travel study costs be covered by trip participants, not by the institution. Prices listed for the trip are good faith estimates. Pricing is conditional on minimum enrollment, and can be adjusted depending on enrollment. Pricing adjustments might also be necessitated due to uncontrollable and unpredictable fluctuations in the cost in fuel or other travel expenses. Trip registrants will be informed as soon as possible of any changes in pricing. The travel fee includes bus transportation, hotel, and museum admissions. An optional excursion fee applies if you wish to include Disneyland in your itinerary.

The initial deposit is non-refundable under any conditions. Beyond that, DSU policy allows for travel refunds to be given only to the extent that payments for travel costs have not been made. THERE IS NO GUARANTEE THAT ANY REFUNDS WILL BE MADE IF YOU DROP OUT OF THE TRIP AT ANY TIME. FAILURE TO MEET PAYMENT DEADLINES CAN RESULT IN CANCELLATION OF YOUR SPOT IN THE TRIP AND FORFEITURE OF ANY FEES PAID. All payments are made online at https://commerce.cashnet.com/cashneta/selfserve/StoreLogin.aspx. A 2.75% service fee applies to the credit card online payments. Do not register for this trip if you are not fully confidant of your ability to meet the payment schedule and to travel as scheduled.

DSU students can receive credit for ART 2910R for participation in this trip. The cost of tuition is not included in the trip fees. Participation in the travel experience is required in order to earn a passing grade in ART 2910R.

You are allowed to state roommate preferences, and every effort will be made to honor those preferences. However, trip managers retain the right to make final roommate assignments.

DSU student code and campus rules and regulations, including regulations about alcohol and other substance use apply at all times and in all places for participants during this DSU activity.

I represent that my participation in the trip is voluntary. I personally certify that I am physically able to participate in this strenuous trip, and that I have no physical impairment or disability of any kind which would keep me from participation.

I agree to abide by all specific direction and recommendations of the Dixie State University faculty who are supervising the trip and to comply with all applicable DSU policies and procedures.

I assume all liability for any accident, injury, sickness or death as a direct or indirect result of this trip, which occurs as a result of my participation, except to the extent the injury or death arises as a result of gross negligence or intentional misconduct of Dixie State University or any of its employees or volunteers.

I agree and understand that I will not hold Dixie State University or the State of Utah liable for any accident, injury, sickness, death or any associated cost which may result from my involvement in this activity, and that I will hold Dixie State University and the State of Utah free and harmless from any or all liability and responsibility for my actions and incidents that occur to me, or result from my actions.

I understand that Dixie State University does not have any insurance or fund of any kind which can or will insure me personally against injury, harm, or death, which may result from my participation in this activity. I must personally pay any cost for these consequences, or I must personally arrange and pay from my personal coverage through commercial insurance sources.

I certify that I have signed this Agreement voluntarily, without any coercion or duress and with a full and accurate understanding of its meaning and effect.

I agree that if emergency conditions arise and I am unable to give my consent for emergency treatment or care, the faculty of Dixie State University, any ambulance or hospital emergency room doctors, nurses and technicians may render appropriate medical treatment until I or a responsible member of my family.

By clicking Submit you agree to the above conditions
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