APPLICATION
St Hugh’s College - Oxford University

Summer School 2010

Please complete the Application form online and then print it together with the Agreement form. Both forms must be signed and dated. If you are under 18 years of age, one of your parents or a legal guardian must also sign both forms.

RETURN TO:
St Hugh’s College
Summer School 2008
PO Box 25
Abilene, TX 79604-0025 USA


Please make and retain a copy of both this and the Agreement form.
  Please also include a passport size photograph of yourself.

Personal Information

Full Name (as it appears or will appear on your passport )


Social Security Number


Preferred Name


Date of Birth (mm/dd/yyyy)


Home Address (including ZIP or postal code)



Home telephone number
- -

Email address


Size St Hugh's College T-shirt you would like if accepted into the programme:
XS S M L XL

Academic Information

High School/College you are currently attending

Year in High School/College
Cumulative Average as of

Name of teacher you have asked to recommend you


Position


Email address


Academic subject you wish to study in tutorials


Please attach a 300-word statement in which you state why you wish to study this particular subject and how you intend to pursue it (e.g. from an historical, a literary, a sociological point of view). Include a clear thesis statement.

Health Information

Insurance Company


Policy Number


Please list and explain any health conditions a doctor should be aware of before treating you, including allergic reactions to medicine, medicines you are presently taking, and chronic conditions. Also list any dietary restrictions.

Travel Information

I wish information regarding point-to-point transportation to/from St Hugh's College.

I wish to arrange my own transportation to/from St Hugh's College. I understand and agree that I am to arrive at St Hugh's College by 12:00 noon on Saturday 17 July 2010.


Emergency Information

Please give the name, relationship, email address and telephone numbers of a parent, guardian or other person who should be contacted in case of emergency, or for any other reason.

Name


Relationship


Email Address


Telephone numbers : Home
- -
Telephone numbers : Work
- -
Telephone numbers : Cell
- -

IMPORTANT: This Application must be signed and dated. If you are under 18 years of age, it must also be signed by a parent or legal guardian. Please read the following statements before signing.

I certify that the information provided on this Application is complete and true to the best of my knowledge.

I agree to uphold the policies of the St Hugh’s College Summer School and to abide by its rules.


_______________________________________________ DATE_________________
APPLICANT'S SIGNATURE

I certify that I am the parent or legal guardian of the above applicant, that I have read the foregoing Application and that I agree to the participation of _____________________________________ in the St Hugh’s College Summer School.

_______________________________________________ DATE__________________
PARENT'S OR LEGAL GUARDIAN'S SIGNATURE

RELATIONSHIP TO APPLICANT _________________________

(Qualifications of applicants will be considered without regard to race, color, sex, creed or national origin.)

AGREEMENT
St Hugh’s College - Oxford University

Summer School 2010


All applicants must agree to and sign this Agreement as a condition of acceptance of their application to participate in the St Hugh’s College Summer School. If the applicant is under 18 years of age, this Agreement must also be signed by the applicant’s parent or legal guardian.

1. I understand and agree that all references in this Agreement to “St Hugh’s College” and to “St Hugh’s College Summer School” shall include all of its officers, programme directors, advisers, group leaders, employees, agents, and designees, including any tour organizer or arranger employed or utilized by St Hugh’s College. I also understand and agree that all references in this Agreement to the “parents” of the applicant shall include the legal guardian or other adult responsible for the applicant.

2. I agree to disclose any relevant information St Hugh’s College considers necessary to making decisions regarding my participation in and activities related to the St Hugh’s College Summer School. I fully understand that this agreement grants legal permission to the Director of the St Hugh’s College Summer School to access any information, including my cumulative files, and to interview my teachers, counselors and any other person deemed appropriate, relevant or necessary to my final acceptance into the St Hugh’s College Summer School programme.

3. I understand and agree that, if accepted as a participant in the St Hugh’s College Summer School, I will be expected to comply with all rules, standards, regulations and instructions for student behaviour during the Summer School.

4. I further understand and agree that St Hugh’s College has the right to enforce appropriate standards of conduct, and that it may at any time, following a fair hearing, terminate my participation in the Summer School for failure to maintain these standards or for any action or conduct which St Hugh’s College considers to be detrimental to or incompatible with the health, interest, harmony or general welfare of the group as a whole or of any individual participant in particular.

5. I understand and agree that St Hugh’s College Summer School rules include but are not limited to the following. Unless otherwise approved by the Director of the Summer School or his designee, all students must be in College by 10:00 p.m. each night. The possession or consumption of alcohol or any other drug is strictly forbidden and will result in immediate dismissal from the Summer School. Smoking and dipping are forbidden. Students are expected to dress appropriately for all Summer School activities. Independent travel outside of Oxford must be approved in advance and in writing by the Director of the Summer School or his designee.

6. I do hereby waive and release all claims against and agree to hold harmless St Hugh’s College for any injury, loss, damage, accident, inconvenience, delay or expense incurred during or in travel related to the St Hugh’s College Summer School.

7. I do hereby waive and release all claims against St Hugh’s College arising at a time when I am not under the direct supervision of the St Hugh’s College Summer School or arising out of my failure to remain under such supervision or to comply with such rules, standards, regulations and instructions; and I agree to indemnify St Hugh’s College against any consequences thereof.

8. I do hereby grant St Hugh’s College full authority to take whatever actions they may consider to be warranted under the circumstances regarding my health, safety and welfare and I fully release each of them from any liability or expense for such decisions or actions as may be taken in connection therewith during or in travel related to the Summer School. I agree to reimburse St Hugh’s College for any costs incurred in any emergency at my own or my parents’ expense.

9. I understand and agree that it is my responsibility to have adequate health insurance and to carry the proper insurance identification with me.

10. I do hereby waive and release St Hugh’s College and agree to indemnify them with regard to any financial obligations or liabilities that I may personally incur or any damage or injury to the person or property of others that I may cause while participating in the St Hugh’s College Summer School.

11. I understand and agree that I am responsible for any damage caused by myself to St Hugh’s College property. I agree to reimburse St Hugh’s College for any such damages at my own or my parents’ expense.

12. I understand and agree that, in the event St Hugh’s College advances or loans any monies to me or incurs special expenses on my behalf while I am abroad, I or my parents will make immediate repayment to St Hugh’s College.

13. I understand and agree that St Hugh’s College Summer School publications may include statements by me, as well as the use of my photograph/s.

14. I have read the foregoing Terms and Conditions as stated in the section entitled Application. I understand and agree that said Terms and Conditions constitute a part of this Agreement. I further understand that this Agreement shall become effective only upon acceptance of my application by the St Hugh’s College Summer School.

15. Finally, I understand and agree that my failure to comply with any part of this Agreement constitutes grounds for dismissal from the Summer School and that, after a fair hearing, I may be sent home by St Hugh’s College at my own or my parents’ expense with no refund of any part of the programme cost.



___________________________________________ Date __________________
Signature of Applicant

I certify that I am the parent or legal guardian of the above applicant, and that I have read the foregoing Agreement (including such parts as may subject me to personal responsibility), and hereby relinquish any claim that I might have against St Hugh’s College or its agents (as set forth above), both in my own behalf and in my capacity as legal representative of the applicant, including without limitation any claim arising as a result of the applicant's leaving the supervision of St Hugh’s College or at a time when the applicant has left the supervision of St Hugh’s College.

______________________________________________ Date __________________
Signature of Parent or Legal Guardian

Relationship to Applicant ______________________________