PERMISSION/WAIVER OF LIABILITY/MEDICAL INFORMATION/PUBLICITY RELEASE FORM

This form is required to be signed by the parent/guardian of any student or individual (under the age of 18- parental signature required) attending or participating in Five Towns College (FTC) Summer High School Scholars program and the events on campus as well as those who will be participating in any related on or off-campus event or trip, including classroom projects on campus, bus trips, and, including, travel to the Great South Bay Music Festival at Shorefront Park in Patchogue, NY on or about July 20, 2023 by bus from FTC. The College will be providing bus transportation to and from the above event and all invited students/attendees must travel with the group and submit this form.

Please read this information thoroughly. Then, complete the form below, sign it, and indicate your understanding and acknowledgement and intent to participate by signing below and submitting the form online. It will be required in order to attend the Summer High School Scholars program and to board the bus for the Great South Bay Music Festival trip for those students invited from certain classes. For any/all students under the age of 18, a parent or legal guardian’s signature is required, and this form must be submitted to FTC administration prior to the first day of the Summer High School Scholars program on July 10, 2023.

As parent/legal guardian of the student listed in the form below, I give permission for the student/individual named to participate in a Five Towns College event on or off-campus, including bus trip, to travel and attend the Great South Bay Music Festival at Shorefront Park in Patchogue, NY on or about July 20, 2023 with Five Towns College. I, student and/or parent, hereby release, waive, indemnify and hold harmless Five Towns College, including Five Towns College’s trustees, employees, volunteer workers, students, agents, and/or representatives from any and all liability, damage, claim of any nature whatsoever, except gross negligence, arising out of or in any way related to the attendance and participation of my son/daughter and/or student/individual under my guardianship at this event on-or off-campus, at or with Five Towns College.

Participating in any activity is an acceptance of some risk of injury. I understand and agree that this is a responsibility of my son/daughter and/or student/individual under my guardianship. Despite precautions, accidents and injuries may occur and injury and/or loss or damage to personal property may occur as a result of participation. Therefore, I assume all risks related to the activities, except gross negligence as stated above.

In case of an emergency and if I cannot be reached, I do hereby authorize a representative of Five Towns College to consent to any medical treatment or care deemed advisable. I am aware that medical assistance cannot be provided by the College’s health center and that no Five Towns College employee or student may administer medication.

I/we, parent and child/student, have read and agree to comply with the College’s Institutional Policies and Code of Conduct in the Student Handbook and referenced in the Summer High School Code of Conduct (that supplements the FTC Code of Conduct). This includes an express acknowledgement that NYS law prohibits all use of illegal drugs and prohibits the drinking of alcoholic beverage by persons under 21 years of age. Further, I hereby acknowledge and agree that my son/daughter and/or student/individual will not use or consume alcohol or illegal drugs while participating in any on or off-campus event and will abide by the Code of Conduct at all times and that he/she/they are fully aware, informed and acknowledge understanding of this agreement.

Publicity Rights

By performing and/or participating in the programs, showcases, and events of any kind, live and/or recorded, Five Towns College and Summer High School Scholars students consent to the inclusion of their name, photograph, likeness and/or biographical information in all promotion or advertising for these events and for the commercial release of any recordings, films or programs created by the College.

My signature below indicates that I have read, understood, acknowledge, agree and voluntarily signed this agreement. I expressly agree that this agreement shall be construed, enforced and falls within the jurisdiction of NYS. I agree that this Permission/Waiver/Medical Information/Publicity Release is intended to be as broad and inclusive as permitted under NYS law so that if any portion hereof is held invalid, the balance shall continue in full legal force and effect.

2023 Summer Scholars Drop-Off/Pick-Up Procedures

To ensure the safety of our community, we kindly request that drivers act with caution and care throughout our parking lot and roadways. For the safety of fellow drivers, pedestrians, and public transportation, please be aware of the following policies:

1. The marked speed limit on campus is 5 miles per hour.
2. Parking or standing vehicles in fire lanes – namely along the main pathway in front of the campus entrance – is prohibited.
3. Vehicles may park in marked parking spaces.
4. Disregarding these policies may result in vehicles being towed at the owner’s expense or withdrawal from program.

DROP-OFF

1. Please enter the College through the south entrance on Burrs Lane.
2. Follow signage to proceed through the parking lot and around to the front lane of the school.
3. Students may be dropped off at the front awning where sign is.
4. If you are waiting for your student, please do not hold your vehicle along the fire lane or entry circle. Instead, park in a marked spot.

PICK-UP

1. Please enter the College through the south entrance on Burrs Lane.
2. Park your vehicle in a marked, open space. Please do not hold your vehicle along the fire lane or entry circle.
3. Please text your student once parked on campus and request that your student meet you at your parked vehicle to depart or park your vehicle and walk to front entrance to meet your student.

NOTE: Five Towns College does not assume any responsibility in coordinating students’ departure from campus. It is the responsibility of students and their families to communicate about transportation to and from campus.

By signing the form below, I understand my responsibilities for safety on campus roadways and agree to the above guidelines.

Summer High School Scholars Code of Conduct

On behalf of my son/daughter/student/individual who is enrolled in the Five Towns College Summer Scholars program, I agree to the following Code of Conduct (that supplements the Five Towns College Code of Conduct):

• I will treat all members of the Five Towns College community with respect and dignity, just as I would like to be I will engage with others in a professional and cordial manner.
• I will not use profanity, derogatory statements, sexist/racist language, or any statements that may be offensive to others.
• I will not smoke/vape tobacco, marijuana, THC/CBD oils, or any other substance. I will not consume any other illegal substance.
• I will not consume any alcoholic products.
• I will not wear any clothing/attire/graphic tees that could be offensive.
• I will not engage in any behavior that could be deemed inappropriate. This includes but is not limited to acts of a sexual nature.
• I will not bring any weapons/pocket knives/box cutters, water guns, or nerf projectiles toys to campus.
• I will not enter any restricted areas on campus without permission or a staff escort.
• I will not use skateboards, hoverboards, Segways, scooters, bicycles, on campus.
• I will not wander around or off campus without staff permission/supervision.
• I will always follow staff instructions regarding the use of the College’s equipment and handle it with care.
• I will refrain from aggressive/threatening behavior towards anyone within the Five Towns College community.

Please keep in mind that The Upbeat Café is cashless. Therefore, students must have money loaded onto their FTC ID cards or have a Debit, Credit Card, or Apple Pay to pay for their meals.

This link can be used to put money onto their FTC ID cards: https://cardprogram.ftc.edu/

• Burger with Fries or Chips, Small Water or Can of Soda:  $6.50
• Cheeseburger with Fries or Chips, Small Water or Can of Soda: $6.50
• Chicken Tenders with Fries or Chips, Small Water or Can of Soda: $6.50
• Chicken Sandwich with Fries or Chips, Small Water or Can of Soda: $6.50
• Peanut Butter and Jelly Sandwich with Fries or Chips, Small Water or Can of Soda: $6.50
• Mozzarella Sticks with Fries or Chips, Small Water, or Can of Soda: $6.50
• Salad (With Grilled Chicken $2.00 Additional): $6.95
• Sandwiches with Boars Head Cold Cuts – Prices Vary Depending on Ingredients: $5.00-$7.00
• Also available will be Yogurt Parfaits and Fruit Cups at individual prices as well as other Snack Items, (Chips, Cookies) and a Full Line of Beverages at individual prices.