UCI Student Center & Event Services · Event Liability Waiver Information Form

The form below is for an SCES event client. The information you provide will be sent to the Student Center & Event Services and Risk Management offices.

If you are not working with SCES on the event, contact Risk Services directly about your waiver needs. SCES will not follow up on submissions from non-SCES clients.

Your Contact Information

Your Name *

First

Last

Your Email *

Waiver Type

Waiver Type (select all that apply)

· We can use an electronic waiver, as event participants are expected to have access to electronic devices with internet.
· We are requesting an exception to have a paper waiver because our event participants are not likely to have access to electronic devices with internet.
· Minors will be involved at the event. (Any individual under the age of 18.)
· In-person daytime event
· In-person overnight event
· Virtual event
· Virtual event with scientific or intellectual property being recorded or presented to an external audience (waiver/consent form recommended, but not required)

Event Sponsor Details

Name of Event Sponsor *

Organization or individual

Client Type (select all that apply)

· Registered Campus Organization
· UC Department
· Off-Campus Guest

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.

Contact Name *

First

Last

Contact Phone Number *

Contact Email *

Event Information

Event Name *

Event Dates *

Include start date to end date

Event Description *

Brief statement that focuses on the program goal and activities

Program Description *

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.)

Upload Program Description or Agenda (optional)

File types allowed: .doc, .xls, .ppt, .pdf, .png, .gif, .jpg. Maximum filesize: 8MB.

Will there be any optional/voluntary activities? If yes, please explain/describe.

List all UC Irvine venues that will be used for this event

List all non- UC Irvine venues associated with this event:

Will any food or beverages be served at the event? *

Yes
No

If food or beverages will be served, please explain what will be served and where the food will come from.

(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

Who will be responsible for arrival and departure management of all participants? (select all that apply)

· They are driving themselves
· Event sponsor to provide shuttles/buses/other transportation
· Schools will bus participants to campus
· Other (may require additional permissions)

If you selected "Other" above, please explain.

Will minors be involved in this event? *

Yes
No

If yes, who will be responsible for the minors' supervision during the day?

Event sponsor
Their parent or guardian
Other (may require additional permissions)

If you selected "Other" above, please describe the minor's relation to the supervisor.

If the event involves minors and is an overnight program, who will be responsible for the minors' supervision overnight?

Event sponsor
Their parent or guardian
Other (may require additional permissions)

If you selected "Other" above, please describe the minor's relation to the supervisor.

Overnight Programs

If this is an overnight program, will on-campus University Housing be provided?

Yes. Please name the housing complex below.
No, they will be housed in an off-campus hotel.
No, other (may require additional permissions). Please describe below.

If this is an overnight program, please name the housing complex or venue.

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.

Event Liability Waiver Information Form

Event Liability Waiver Information Form

Please be advised

Your Contact Information

Waiver Type

Event Sponsor Details

Waiver/Program Contact Information

Event Information

Responsibilities

Overnight Programs

Information

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