Girls Who Code

INFORMATION FOR VISITORS TO KANSAS STATE UNIVERSITY SALINA

Welcome to Kansas State University Salina! Campus visits are an excellent opportunity for you to learn more about life as a future K-State student. We urge you to participate in the various academic, social, and experiential components of a K-State Salina education.

PERMISSION/MEDICAL RELEASE FORM

This form is required for any visiting student. Submit it to our office at least four business days prior to your scheduled visit. You will not be allowed to participate without this completed form.

Student Information

First Name

Last Name

Birthdate

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Primary Phone

Mobile Phone

Parent/Guardian Information

Parent First Name

Parent Phone Number

Parent Last Name

Parent Email

Emergency Contacts (If Parent/Guardian Cannot Be Reached)

Relationship

Parent First Name

Parent Last Name

Parent Phone Number

Contact First Name

Contact Last Name

Contact Phone Number

Relationship

Parent First Name

Parent Last Name

Parent Phone Number

Contact First Name

Contact Last Name

Contact Phone Number

Allergies/Medications

Student's allergies

Special Medical Concerns/Conditions

Student's Current Medications (Please list current medications and dosage)

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In consideration of my child being allowed to participate in the visit hosted by the Kansas State University Salina Aerospace and Technology Campus, I, the undersigned parent or guardian, agree on behalf of myself and my child to grant permission for my child to participate in the visit and further agree as follows:

I and my child agree that we must conduct ourselves in a manner so as not to substantially disrupt or interfere with others’ participation(s), in accordance with the conduct standards generally expected of University students (such as the Student Code of Conduct, Threat Management Policy, and Anti-Discrimination and Harassment Policy (all available via k-state.edu/policies)), and any additional safety or conduct directives provided by staff. I understand if my child fails to comply with applicable rules or behavioral standards, my child is subject to disciplinary action, including but not limited to being removed from the visit. Further, I understand that any negative behavior will be considered by the Admissions Office and may impact my application to Kansas State University Salina Aerospace and Technology Campus.
I am aware that visit participants are required to abide by Kansas state law and the Code of Non-Academic Conduct which governs students enrolled at Kansas State University Salina Aerospace and Technology Campus. I acknowledge that Kansas law prohibits use of illegal drugs and the drinking of alcoholic beverages by persons under 21 years of age.

I and my child fully realize the risks associated with participation in the visit, and I and my child fully ASSUME THOSE RISKS. For my child and myself, I WAIVE, RELEASE, AND DISCHARGE Kansas State University, the State of Kansas, the Kansas Board of Regents, and all their agents, officers, and employees, from all claims, demands, and causes of action of any kind, including claims for negligence, invasion of privacy and/or any other claim, which may arise from or be related to my child’s participation in the visit.
I waive any rights to and consent to the recording and use of my child’s image and likeness by K-State. I understand and voluntarily authorize it to: (1) record my child’s participation and appearance on videotape, audio tape, film, photograph, electronic data or image, and/or any other medium (collectively referred to a “Photographs”); (2) use and/or publish my child’s name, likeness, voice, biographical material, and/or other private and/or public facts and/or opinions (collectively, “Likeness”) in connection with or separate from these Photographs; (3) exhibit and distribute such Photographs and/or Likeness for any purpose which K-State deems appropriate. I understand and consent that my child’s Likeness and any Photographs may be posted on and/or accessible to the public via the Internet and other media. I waive any right that I or my child may have to inspect and/or approve any finished Photographs or Likeness products or the use to which it may be applied, and I understand and consent that neither I nor my child will receive financial compensation in exchange for use of the Photographs and/or Likeness.

This Consent is a continuing consent, waiver, release, and assumption of risk with no limitations or reservations, unless and except those stated herein, and is binding on me and my child and our heirs, executors, administrators, legal representatives, assigns and successors in interest. Any copy of this document has the full force and effect and is binding as the original.

Notice of Nondiscrimination
Kansas State University prohibits discrimination on the basis of race, color, ethnicity, national origin, sex (including sexual harassment and sexual violence), sexual orientation, gender identity, religion, age, ancestry, disability, genetic information, military status, or veteran status, in the university's programs and activities as required by applicable laws and regulations. The person designated with responsibility for coordination of compliance efforts and receipt of inquiries concerning the nondiscrimination policy is the university's Title IX Coordinator: the Director of the Office of Institutional Equity, equity@k-state.edu, 103 Edwards Hall, 1810 Kerr Drive, Kansas State University, Manhattan, Kansas 66506-4801. Telephone: 785-532-6220 | TTY or TRS: 711. The campus ADA Coordinator is the Director of Employee Relations and Engagement, who may be reached at charlott@k-state.edu or 103 Edwards Hall, 1810 Kerr Drive, Kansas State University, Manhattan, Kansas 66506-4801, 785-532-6277 and TTY or TRS 711.

Consumer Information Disclosure
The Annual Security Report (Clery Report) is intended to inform the public of information about crime on and around campus, efforts to improve campus safety, and university policies. Its purpose is to provide individuals with information that will help them make informed decisions relating to their own safety and the safety of others. The Annual Security Report may be found at http://ww.k-state.edu/studentlife/reportsandpolicies/. Anyone, including prospective students and employees, may obtain a paper copy by contacting the Office of Student Life.

Parent/Guardian Signature