Event Liability Waiver Information Form

Please be advised

The information provided in this document will be used to address student safety, specific insurance requirements and risk issues.

Therefore, all information must be true, honest and accurate.

See https://aisc.uci.edu/policies/pacaos/code-of-student-conduct-handbook.pdf

Please complete the form below. The information you provide will be sent to the Student Center & Event Services and Risk Management offices.

Your Contact Information

Waiver Type

Event Sponsor Details

Organization or individual

Waiver/Program Contact Information

The information provided in this section will be listed on the waiver in case participants and/or parents/guardians have questions about the event and/or its activities.

Event Information

Include start date to end date
Brief statement that focuses of the program goal and activities
Must include a full agenda with times (start and end), locations (e.g., Pacific Ballroom A or Aldrich Park) and activities (lecture, sports activity, lunch, reception, dance, etc.)
File types allowed: .doc, .xls, .ppt, .pdf, .png, .gif, .jpg. Maximum filesize: 8MB.
(e.g., snacks will be provided by event sponsor, participants will be eating in the Residential Dining Commons and/or lunch will be ordered from UCI Catering)

Responsibilities

Overnight Programs

Any false, misleading or intentionally inaccurate information may subject the author, as well as the entire RCO, to disciplinary action and may affect the organization’s reservation privileges. By submitting this form, I attest to the accuracy of the information provided.