Airport Pick-up Request

Admissions/CIE – Transportation to Rider University

I understand that the transportation from the airport to Rider University, Lawrenceville or Princeton campus, in which I have chosen to participate, involves certain risks, including but not limited to injuries resulting from: auto accidents, physical activity as well as slips and falls. I will adhere to all trip guidelines given to me by my advisor and/or trip chaperone including but not limited to meeting places and meeting times. I also understand that if I choose to leave the main attraction and/or group that I am doing so at my own risk. In the event of an unavoidable reason that prevents me from taking the transportation provided by the University, I assume all responsibility to transport myself to and from the event and the cost associated with such transportation.

Therefore, with acknowledgment of the potential risks involved with this activity, I expressly and knowingly release, hold harmless and agree to indemnify Rider University, its employees, representatives, officers, advisors and agents, from any and all claims and causes of action for property damage, personal injury or death sustained by me and/or caused by me arising out of any travel associated with the activity or the activity itself.

In addition, I understand and agree that Rider University cannot be expected to control all risks. Therefore, I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility.

I understand that, as a Rider University student, I am responsible for adhering to any and all rules and regulations as put forth by Rider University in The Source, and particularly those concerning the use, possession and/or consumption of drugs and alcohol.

I understand that it is my responsibility to arrive on time at the designated location(s) for both departures to and from the activity as indicated by the trip coordinator(s). Should I neglect to arrive promptly at the designated location(s), I understand that I risk being excluded from transportation to and from the destination of the trip, and assume all risks and responsibility thereby incurred.

I understand that should any of the conditions be violated, the trip coordinator has the discretion to follow through with any civil, criminal or university judicial procedures.

The Health Insurance Portability and Accountability Act (HIPAA) allows for the disclosure of your protected health information from a health care provider (hospitals) to individuals involved in your care or for the purpose of notifying family members. In the event you are hospitalized, administrative staff at Rider may need information about your health in order to provide family members with timely and accurate information about your condition. Please be aware that signing this form is completely VOLUNTARY, remains in effect until such time as your enrollment at Rider University ends and may be revoked, in writing, at any time. This form will remain on file with the university and presented to the health care provider in the event you require medical treatment.