Hold Harmless Data Form

HOLD HARMLESS DATA SHEET USE FOR ON OR OFF-CAMPUS ACTIVITIES THIS DATA SHEET TO BE FILLED OUT BY ORGANIZER(S) OF ACTIVITY **PLEASE FILL IN ALL APPLICABLE BLANKS
KSU Campus:
Request Date:	mm/dd/yy
Activity Date:	mm/dd/yy
Organizer name:
Email:
College/Organization:
Course:
No:
Section:
Nature of Activity:
	(Field trip, site visitation, etc.)
Activity Destination:
Type of Transportation:
	(Privately-owned, university, military, public)
Name of Assistants:
	(specify faculty, graduate, student)
Outside Organizations:
	Name and address of outside organization(s) involved with this activity (Govt agency, private company, individual)
Risk:
	Risks specific to this activity
Accommodations:
	Other than transportation, list any special accommodation(s) related to this activity (motel, restaurant, etc.)
Under 18:
	Are there any students involved who are not age 18 or older?
Course requirement:
	Is the activity a requirement for the course?
Degree requirement:
	Is the course a requirement for a degree program?
Listed requirement:
	Is the activity listed as a course requirement in the catalog?
Comments: