EXPEDITION APPLICATION & RELEASE - PLEASE PRINT and MAIL COMPLETED APPLICATION & RELEASE TO:
Dr. Jonathan Kent, Department of Anthropology
The Metropolitan State College of Denver
Campus Box 28, PO Box 173362
Denver, CO 80217-3362
If you have questions, please call 303-556-2933 or email kentj@mscd.edu
*** A deposit of $250.00 should accompany your completed application and signed release.

If seeking college credit, make deposit check payable to MSCD. If not seeking college credit, make deposit check payable to CIPS.

Expedition Session: (circle one)   1   or   2?
Number of weeks __________ (Three or six)
Name: Birthdate:
Mail Address:
Passport No.:
Phone: (Home) (Work):
Email: Fax:
 
Emergency Contact Name: Relation:
City: Phone (day): (Eve.):
Your occupation: Employer:
If retired, former occupation:

EDUCATIONAL BACKGROUND:

 

 

 

PRIOR ARCHAEOLOGICAL EXPERIENCE (When, where, kind of involvement):

 

 

FOREIGN TRAVEL (Where, when and nature of experience):

 

 
MEDICAL CONDITIONS (Medical treatment may not be readily available. Please note any special medical conditions. A physical examination is recommended.)
Blood Type Diabetes Epilepsy Asthma
Special Medication Diet Restriction
Problem Allergies
Bad back, trick knee, etc.
Heart Problems
Hospitalization in last 2 years
Date of most recent physical examination
Comments (include any psychological treatments):
 
PERSONAL ASSESSMENT   Please comment on and assess yourself in the following (e.g. no experience, poor, average, outstanding)
Archaeological experience
Experience with another culture
Patience
Ability to work as a team member
Flexibility
Initiative
Sense of humor
Knowledge of Spanish or Quechua
Physical Stamina
Camping/Hiking experience
Vehicle repair
Photography (still)
Photography (video)
Sketching/Illustrating
Technical Drawing/Drafting
Map reading
Surveying
Computer analysis

Additional comments, skills or experience

 

 

 
Release of Liability & Assumption of All Risks
(Please Read Carefully; This is a Legally Enforceable Waiver of Rights)
ASSUMPTION OF RISKS
_____ I, _________________________, acknowledge that I have voluntarily applied to participate on the trip designated on this application. I am voluntarily participating on the tour or expedition with knowledge that travel to foreign countries and/or remote areas visited by this trip involves numerous risks and dangers including, but not limited to, the forces of nature; civil unrest; terrorism; roads, trails, hotels, vehicles, boats or other means of conveyance which are not operated nor maintained to standards common in the United States; high altitude; accident or illness without access to means of rapid evacuation or availability of medical supplies; the adequacy of medical attention once provided; and negligence on the part of The California Institute fr Peruvian Studies, Inc. I acknowledge that the enjoyment and excitement of travel is derived in part from the inherent risks incurred by travel and activity beyond the accepted safety of life at home or work and that these inherent risks contribute to such enjoyment and excitement, being a reason for my voluntary participation.
_____ I HEREBY ACCEPT ANY AND ALL RISKS OF ILLNESS, INJURY, EMOTIONAL TRAUMA, OR DEATH AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE.
RELEASE
AS LAWFUL CONSIDERATION for being permitted by The California Institute for Peruvian Studies, Inc. to participate on such trips and activities. I hereby agree that I, my heirs, legal representatives or any member of my family will not make a claim against or sue California Institute for Peruvian Studies, Inc. or any of its affiliated agents or employees for bodily injury, death, emotional trauma or property damage reulting from my participation in the tour or expedition. I THEREFORE RELEASE AND DISCHARGE THE CALIFORNIA INSTITUTE FOR PERUVIAN STUDIES, INC. AND ITS AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL LIABILITY ARISING FROM MY PARTICIPATION IN THE TOUR OR EXPEDITION.
If any portion of this agreement is unenforceable, the remaining portions shall remain in full force and effect. Under no circumstances shall The California Institute for Peruvian Studies, Inc. be liable to any tour participant for more than $500.00. All applications are subject to acceptance by The California Institute for Peruvian Studies, Inc.. Upon acceptance of my application, this agreement shall be deemed to have been entered into and to be performed at Sacramento, California and shall be construed according to the laws of the State of California. In the unlikely event a legal dispute should arise involving any subject matter whatsoever, I agree that the dispute shall be settled by binding arbitration through the American Arbitration Association at San Francisco, California. Should this arbitration provision be held unenforceable, I agree that any legal action shall exclusively be brought before the appropriate State Court in Sacramento County, California.
KNOWING AND VOLUNTARY EXECUTION
I have carefully read and fully understand the contents of this Agreement. I am aware that this is a release of liability and a legally binding and enforceable contract between myself and The California Institute for Peruvian Studies, Inc. and sign it of my own free will.
Executed this _____ day of ______________________, 20___
SIGNATURE OF APPLICANT