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2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
STUDENT INFORMATION
Name (as it appears on your passport) __________________________________________________
Passport # ____________________________
DOB ___________________
Passport Expiration Date____________
Gender ________
Cell Phone ________________________________
Email _____________________________________________
Address __________________________________________________________________________
City _________________________________________ State ___________ Zip _____________
PARENT/GUARDIAN INFO
INFORMATION
RMATION
Parent _______________________________
Parent __________________________________
Phone ________________________________
Phone __________________________________
Email ________________________________
Email __________________________________
Address __________________________________________________________________________
City __________________________________________ State ____________ Zip ___________
* Parent(s)/ Guardian(s) will receive daily email updates during the trip.
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2014
CRITICAL INFORMATION
1. Payment and Deadlines
•
Total Program Fee: $750.00
•
Deposit: $150.00 non-refundable deposit is required with your application.
•
The deadline for submitting application materials and deposit is Friday, April 17, 2015.
•
The outstanding balances of $600 must be paid prior to Friday, May 30, 2015.
•
Your passport must be received in the OUCI office by Friday, May 29, 2015.
2. Passport: You are responsible for your passport. Please apply for your Passport as early
as possible, because once you receive it you will still need to apply for your Chinese VISA.
If you currently have a passport, it must have at least six (6) months validity left before expiration and at
least two blank pages together.
3. Visa to China: You must have a Chinese Visa to participate in this trip.
OUCI will arrange for your Chinese Visa. If you are located in the Houston area and want to visit
the Chinese consulate, please email [email protected] prior to submitting your balance.
•
Please fill out and sign the included visa application form.
•
Include two (2”x2”) recent passport photos.
•
Once OUCI receives your passport from the Chinese Consulate, we will contact you and ask you to
pick it up from our Norman or Tulsa office, or you can request that it be mailed to you.
Note: If you are American born Chinese, please contact Rex Burnett for additional instructions.
4. International airfare: OUCI will NOT handle the group tickets purchase. Your ticket will be
reserved through a competitive travel agency. Due to the high demand of flights to China, it is very
important that you book your air tickets as soon as possible.
You may use other resources to book your ticket, but your flights must fit our group itinerary.
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone:
(918)660-3490
660-3497
Fax: (918)
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
PARENT/GUARDIAN STAT
STATEMENT
EMENT
I _______________________________being the parent or duly authorized guardian of
______________________, do hereby give my consent for___________________ to participate in the
2015 OUCI Chinese Bridge Summer Camp. I also confirm that my son/daughter is in good health and
able to meet the physical demands of this trip. If my son/daughter is selected to participate in the trip, and
he/she accepts, I will be responsible for paying all fees in full by the stated deadlines.
___________________________
Parent/Guardian signature
STUDENT STATEMENT
If selected to participate in the 2015 OUCI Chinese Bridge Summer Camp, I will do my best to represent
my family, school, and country in a manner befitting myself and the University of Oklahoma.
___________________________
Student signature
Before me, a Notary Public in and for said County and State, on this _____ day of ___________, 20____,
personally appeared________________________________________, to me known to be the identical
person who executed the within and foregoing instrument and acknowledge to me that he/she executed the
same as his free and voluntary act and deed for the uses and purposes therein set forth.
________________________________________
Notary Public
____________________________
Date Commission Expires
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
STUDENT
CONDUCT AGREEMENT
STUDENT CONDUCT
AGRE
AGREEMENT
EMENT
I, _______________________________ UNDERSTAND THAT I WILL BE REPRESENTING THE UNIVERSITY
OF OKLAHOMA AND THE UNITED STATES OF AMERICA DURING THIS STAY IN CHINA AND THAT I WILL
BE EXPECTED TO MAINTAIN A STANDARD OF BEHAVIOR AND DECORUM THAT WILL REFLECT POSITIVELY
ON THE UNITED STATES OF AMERICA, THE UNIVERSITY OF OKLAHOMA AND THE CONFUCIUS INSTITUTE.
I AGREE TO ABIDE BY THE FOLLOWING EXPECTATIONS, WHICH INCLUDE, BUT ARE NOT LIMITED TO:
•
•
•
•
•
The consumption of alcohol is strictly forbidden and will result in immediate dismissal from the program.
Engaging in any sexual or other inappropriate conduct is strictly forbidden and will result in
immediate dismissal from the program.
I will be financially responsible for any damage done by me to any lodging or transportation.
I will follow all rules established by the hosting institution or trip leaders as they see fit.
I will participate in all scheduled activities. If I am unable because of a physical ailment, I must
inform my trip leaders immediately.
I RECOGNIZE THAT OUCI IS NOT RESPONSIBLE FOR MONITORING ALL THE DAILY PERSONAL
DECISIONS, CHOICES, AND ACTIVITIES OF INDIVIDUAL PARTICIPANTS. IF I FAIL TO COMPLY WITH THE
TERMS AND CONDITIONS OF THIS AGREEMENT, I UNDERSTAND THAT MY IMMEDIATE DISMISSAL FROM
THE TRIP, AT MY OWN PERSONAL COST, WILL BE RECOMMENDED. I ALSO RECOGNIZE THAT ALL FINAL
DISCIPLINARY DECISIONS WILL BE MADE BY MY TRIP LEADERS.
____________________________________________
(STUDENT SIGNATURE AND DATE)
PARENT STATEMENT:
I, _______________________________ THE UNDERSIGNED AGREE TO PAY ALL EXPENSES
ASSOCIATED WITH EMERGENCY INTERNATIONAL TRAVEL SHOULD _____________________(STUDENT’S
NAME) BE DISMISSED FROM THIS PROGRAM BECAUSE OF INAPPROPRIATE BEHAVIOR. FEES MAY INCLUDE
TAXI, BUS, OR OTHER PUBLIC TRANSPORTATION TO AND FROM AIRPORTS, FEES ASSOCIATED WITH
CHANGING DEPARTURE DATES AND/OR AIRLINES TO ACCOMMODATE IMMEDIATE DEPARTURE. I WILL
ALSO PAY ANY ADDITIONAL CHARGES SHOULD THERE BE ANY AT THE TIME OF MY STUDENT’S
DEPARTURE BECAUSE OF DISCIPLINARY ACTION.
____________________________________________
(PARENT OR GUARDIAN SIGNATURE AND DATE)
OUCI WILL REVIEW THE CIRCUMSTANCES AND CONSULT WITH THE STUDENT AND HIS/HER
PARENT(S) SHOULD SERIOUS OR SEVERE DISCIPLINARY ACTION BE REQUIRED OR IMMEDIATE
DISMISSAL BE RECOMMENDED.
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
TALENT RELEASE AND L
LIABILITY
IABILITY WAIVER
In consideration of my minor child being permitted to participate in the activities associated with the
2014 Chinese Bridge Summer Camp program, I agree that this Release, Waiver Discharge and
Covenant not to Sue (Release) is executed on this ______ day of ___________________, by
__________________________________________________ a minor child and
________________________________________, the parent having legal custody and/or the legal
guardian of the minor in favor of the Board of Regents of the University of Oklahoma (University).
I know the nature of the events and the minor’s experience and capabilities, and I believe the Minor to
be qualified to participate in the Chinese Bridge Summer Camp program.
I consent to the Minor’s participation in the Summer Camp Program and hereby accept and assume all
risks and I fully understand and appreciate the dangers, hazards and risks inherent in the Activity, in
the transportation to and from the Activity, and in any activities the minor undertakes as a participant
to the Activity, which could include serious or even mortal injuries and property damage.
Knowing the dangers, hazards and risks of such activities, and in consideration of being permitted to
participate in the Activity, on behalf of myself, my family, heirs and personal representative(s), I, the
undersigned, agree to assume all the risks and responsibilities surrounding the minors participation in
the Activity, the transportation, and in any independent research or activities undertaken as a participant thereto, and in advance release, waive, forever discharge, and covenant not to sue the University
of Oklahoma, its governing board, officers, agents, employees, and any staff acting as chaperones
(hereinafter University), from and against any and all liability for any harm, injury, including, but not
limited to, suffering and death, that may be sustained by said minor or by any property belonging to
minor, whether caused by the negligence or carelessness of the University, or otherwise, while in, on,
upon, or in transit to or from the premises where the Activity, or any participant to the Activity, occurs
or is being conducted.
I understand and agree that University does not have medical personnel available at the location of the
Activity or on the campus. I understand and agree that University is granted permission to authorize
emergency medical treatment, if necessary, and that such action by University shall be subject to the
terms of this Agreement. I understand and agree that University assumes no responsibility for any
injury or damage which might arise out of or in connection with such authorized emergency medical
treatment.
It is my express intent that this release and hold harmless agreement shall bind the members of my
family and spouse, if I am alive, and my estate, family, heirs, administrators, personal representatives,
or assigns, if I am deceased, and shall be deemed as a “Release, Waiver, Discharge and Covenant” not
to sue the above-named University. I further agree to save and hold harmless, indemnify, and defend
University from any claim by me or my family, arising out of the minor’s participation in the Activity.
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
In signing this Release, I acknowledge and represent that I have fully informed myself of the content of
the foregoing waiver of liability and hold harmless agreement by reading it before I sign it, and I
understand that I sign this document as my own free act and deed; no oral representations, statements, or
inducements, apart from the foregoing written statement, have been made. I understand that the
University does not require the minor to participate in this Activity, but they want to do so, despite the
possible dangers and risks and despite this Release. I further state that I am the legal guardian of said
minor and am fully competent to sign this Agreement; and that I execute this release for full, adequate,
and complete consideration fully intending to be bound by the same. I further state that there are no
health-related reasons or problems which preclude or restrict the minors participation in this Activity,
and that said minor has adequate health insurance necessary to provide for and pay any medical costs
that may be attendant as a result of injury to the minor.
I further agree that this Release shall be construed in accordance with the laws of the State of Oklahoma.
If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law
governing this Release the validity of the remaining portions shall not be affected thereby.
Minor and Guardian also hereby agree and consent to allow the University of Oklahoma’s Confucius
Institute to photograph or videotape the above-named person for publicity purposes and waive all
claims for any compensation for such use or for damages.
IN WITNESS WHEREOF, I have executed this Release this _______ day of _______, 20___.
PARTICIPANT
WITNESS
____________________________________
(Printed Name)
____________________________________
(SIGNATURE AND DATE)
_____________________________________
(Signature)
_____________________________________Parent’s Printed Name
_____________________________________Parent’s Signature
2015 OUCI Chinese Bridge Summer Camp Application
CONFUCIUS INSTIUTUTE AT OU-TULSA
4502 East 41st Street
Tulsa, OK 74135
Phone: (918) 660-3497
Fax: (918) 660-3490
APPLICATION DEADLINE
FRIDAY, APRIL 17, 2015
CHECKLISTFORACOMPLETEAPPLICATION
Completed OUCI Summer Camp Application Form
Signed and notarized “Parent/Guardian statement” and “Student statement” Form
(a notary is available at OU-Tulsa)
Signed Student Conduct Agreement
Signed Talent Release and Liability Waiver
Non-refundable deposit $150 check made payable to University of Oklahoma
Passport AND 2 Passport Photos (2”x2”)
Completed Chinese Visa Application
Proof of International Insurance (including repatriation)
You may deliver or mail all completed documents and check in one envelope to:
Application must arrive by April 17, 2015
Confucius Institute at the University of Oklahoma
4502 East 41st Street
Tulsa, OK 74135
ATTN: Rex Burnett
Thank you for your interest in our programs.
Please email Rex Burnett: [email protected] with questions or for more information.