Congress of the South 40
FALL 2014
Election Materials
(To be printed out and turned in)
All Residential Colleges
Morgan Ippolito
CS40 Election Commissioner
[email protected]
CS40.wustl.edu
Elections are on Wed. Sept. 10th, 2014
Please turn in this form by 5:00p Mon. Sept. 8th, 2014
The Election Commission
Membership and Contact Information
Please feel free to direct questions to any member of the Election Commission at
any time. Listed below is contact information for Morgan Ippolito, the Election
Commissioner, as well as the names of other people on the Election Commission. We
appreciate your interest in running for the Congress of the South Forty!
Congress of the South 40
6515 Wydown Blvd.
St. Louis, MO 63105
Office Phone: (314)-935-5057
Website: CS40.wustl.edu
Facebook: facebook.com/cs40.wustl
Morgan Ippolito
Election Commissioner
[email protected]
CS40 Executive Board Members
Lucy Chin
[email protected]
Gabrielle Buchbinder
[email protected]
Jack Goodman
[email protected]
Emily Duncan
[email protected]
Aashna Narang
[email protected]
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CS40 Fall Election 2014
Petition for Candidacy:
Legal Name: _____________________________________________________________
How you’d like your name to appear on the ballot: _______________________________
Student ID Number: ______________________________________________________
Cell Phone Number:
_____________________________________________________
Email Address (wustl): ___________________________________________________
Residential Hall and Room: ________________________________________________
Campus Box (Local Address): _______________________________________________
Position Sought: _________________________________________________________
We need the following information in preparation for the CS40/XRHH Retreat
from September 19th to 20th, 2014 (As well as a completed waiver; see the end of the
packet)
Emergency Contact Name (i.e. Parent/Guardian): _______________________________
Emergency Contact Relationship:____________________________________________
Emergency Contact Address:________________________________________________
Emergency Contact Phone Number:___________________________________________
Allergies:________________________________________________________________
Accommodations you may need:_____________________________________________
**Please Write Legibly! **
I hereby agree to follow the Election Rules and Regulations as outlined in this packet.
Furthermore, I agree to follow all rules established by the Election Commission of the
Congress of the South 40 to the best of my ability.
Candidate Signature:
Print Name:
___________________________________
___________________________________
I am able to attend the College Council retreat on September 19th-20th, 2014 from
4 pm (Friday) to 4 pm (Saturday).
YES _____
NO _____ (please explain)
I understand that if I circle “YES” and do NOT attend the College Council Retreat, I will
be issued a $75 fine to cover the cost paid for me to attend the retreat.
Candidate Signature:
___________________________________
Please bring this completed election packet to your RCD:
I hereby confirm that these are signatures of residents in my residential college.
___________________________________________
RCD Signature
Return this form to the Residential Life Annex (in South 40 House)
by 5:00 PM on Monday, September 8th, 2014.
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Liability Waiver
Statement of Personal Responsibility & Release Regarding Participation in Washington University in St. Louis Student Event
(for students aged 18 or older only)
I, _________________________________________, am student at Washington University in St. Louis (the “University”).
I wish to participate in CS40 Retreat
(“Event”) on September 19-20, 2014 (date) at Camp Wartburg in Waterloo , IL (location), organized by
Congress of the South 40 (Sponsoring Group). I understand that I am asked to participate in this Student Event, but am voluntarily doing so,
despite the potential dangers and risks (as described in more detail below) and despite this Release.
I understand and appreciate the dangers, hazards, and risks inherent to the Student Event, including but not limited to bus transportation to, from, and
around the Student Event area; natural disasters; inclement weather; riots; terrorist activities or attacks; accidents; illnesses; crimes; and any risks
associated with independent activities I undertake as an adjunct to the Student Event, all of which could include serious or even fatal injuries or
property damage or loss. I further understand that the University, including the individuals acting on its behalf, cannot and does not assume
responsibility for such events or personal injuries or property damage arising there from even if such injury or damage is a result of the negligence of
the University or other parties released.
Knowing the dangers, hazards and risks of the Student Event, and in consideration of being permitted to participate in it, on behalf of myself, my family,
heirs, and personal representative(s), I agree to assume all the risks and responsibilities surrounding my participation in the Student Event and, in
advance, release, waive, forever discharge, and covenant not to sue the University, its governing board, officers, agents, employees, students, and
volunteers (collectively, the “Releasees”) from and against any and all liability for any harm, damage, claim, demand, action, cause of action, cost or
expense of any nature that I may have or that may hereafter accrue to me, arising out of or related to any loss, damage or injury, including but not
limited to physical injury, suffering or death, that may be sustained by me or by any property belonging to me, whether caused by the negligence or
carelessness of the Releasees with regard to the Student Event. It is my express intent that this Release shall be deemed a release, waiver,
discharge and covenant not to sue the Releasees. I further agree to save and hold harmless, indemnify, and defend Releasees from any claim by me
or my family arising out of my participation in the Student Event.
I understand that I am expected to behave in a manner consistent with the Washington University Judicial Code, the Washington University Drug and
Alcohol Policy, and all other applicable University policies. I understand that the use or possession of any illegal drugs, including marijuana, can have
very grave consequences, including arrest and imprisonment. I know that I am subject to local law and agree to obey all laws and ordinances of
jurisdictions where I may be during my participation in the Student Event.
I acknowledge and agree that, to the extent the bus and retreat center must be cleaned or repaired as a result of my conduct and actions, I am responsible
for any fees or deposits associated with such cleaning or repairs.
I am aware of my own personal medical needs and state that there are no health-related reasons or problems that preclude or restrict my ability to
participate safely in the Student Event. I assume all risk and responsibility for my medical needs, and understand and agree that if I must be
hospitalized or otherwise receive medical care; the University cannot and does not assume legal responsibility for payment of such costs. I hereby
grant permission to the Releasees to authorize emergency medical treatment for me, and understand and agree that neither the University nor any of
the other Releasees assume any responsibility for any injury or damage that may arise out of or in connection with such authorization.
I warrant that I am at least eighteen (18) years of age and fully competent to sign this Release; that I understand the terms contained herein are contractual
and not a mere recital; that I have read this Release with full knowledge of its significance; and that I have signed this Release as my own free act.
I agree that this Release shall be construed in accordance with the laws of the State of Missouri. If any term provision of this Release shall be held
unenforceable, illegal, or in conflict with any governing law, the validity of the remaining portions shall not otherwise be affected.
THIS IS A RELEASE OF LEGAL RIGHTS.
READ IT AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING.
ACCEPTED AND AGREED:
Signature
Date
______________________________________
Please write name
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Liability Waiver
STATEMENT OF PERSONAL RESPONSIBILITY & RELEASE REGARDING PARTICIPATION IN WASHINGTON UNIVERSITY STUDENT EVENT
1.
My child, _________________________________________, is a student at Washington University in Saint Louis (the “University”).
2.
He/she wishes to participate in a student trip (the “Event”) to the CS40 Retreat on September 19-20, 2014 at Camp Wartburg in Waterloo, IL. I
acknowledge that his/her participation in the Event is entirely voluntary.
3.
I understand and appreciate the dangers, hazards and risks inherent to the Event, including but not limited to transportation to, from, and around the
Event destination, natural disasters, inclement weather, accidents, illnesses, crimes, terrorist activities or attacks, and any risks associated with
independent activities I undertake as an adjunct to the Event, all of which could include serious or even fatal injuries or property damage or loss. I
further understand that the University cannot and does not assume responsibility for such events or personal injuries or property damage arising there
from even if such injury or damage is a result of the negligence of the University or other parties released. I also accept that it is my child’s sole
responsibility to participate only in those activities for which he/she have the prerequisite skills, qualifications, preparation, and training, and that I have
read and understand the conditions applicable to the Event. I further accept and agree that my child will follow all instructions pertaining to the Event,
particularly those regarding safety and security practices.
4.
With full awareness of the dangers, hazards and risks of the Event, and in consideration of being permitted to participate, on behalf of myself, my
family, heirs, and personal representatives, I agree to assume all the risks and responsibilities surrounding my child’s participation in the Event and, in
advance, release, waive, forever discharge, and covenant not to sue the University, or its governing boards, officers, agents, employees, students,
and/or volunteers (collectively, the “Releasees”) for any harm, damage, claim, demand, action, cause of action, cost or expense of any nature that I
may have or that may hereafter accrue to my child, arising out of or related to any loss, damage or injury, including but not limited to physical injury,
suffering or death, that may be sustained by me or by any property belonging to me, whether caused by the negligence or carelessness of the
Releasees in connection with the Event. This waiver does not pertain to incidents involving gross negligence or willful misconduct by the University
and/or its agents. It is my express intent that this release and hold harmless agreement shall be deemed a release, waiver, discharge and covenant
not to sue the Releasees on behalf of my child or on my own. I further agree to save and hold harmless, indemnify, and defend Releasees from any
claim by me or my family arising out of my participation in the Event.
5.
I understand that my child is expected to behave in a manner consistent with the Washington University Judicial Code and all applicable University
policies. I know that he/she is subject to local law and that my child agrees to obey all laws and ordinances of jurisdictions where he/she may be
during his/her participation in the Event.
6.
I am aware of my child’s personal medical needs and hereby warrant that there are no health-related reasons or problems that preclude or restrict my
ability to participate safely in the Event. I assume all risk and responsibility for his/her medical needs, and understand and agree that if he/she must
be hospitalized or otherwise receive medical care, the University cannot and does not assume legal responsibility for payment of such costs. I hereby
warrant that my child has adequate health insurance coverage to meet any and all needs for payment of medical costs while undertaking the Event. I
hereby grant permission to the Releasees to authorize emergency medical treatment for my child, and understand and agree that neither the
University nor any of the other Releasees assume any responsibility for any injury or damage that may arise out of or in connection with such
authorization.
7.
I warrant that I am the parent of the Washington University student participating in this event and that I am fully competent to sign this Release; that I
understand the terms contained herein are contractual and not a mere recital; that I have read this Release with full knowledge of its significance; and
that I have signed this Release as my own free act.
8.
I agree that this Release shall be construed in accordance with the laws of the State of Missouri. If any term provision of this Release shall be held
unenforceable, illegal, or in conflict with any governing law, the validity of the remaining portions shall not otherwise be affected.
ACCEPTED AND AGREED:
(Parent/Guardian Signature)
(Parent/Guardian Printed Name)
THIS IS A RELEASE OF LEGAL RIGHTS.
READ IT AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING.
(Date)
(Student Printed Name)
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Signatures Supporting this Candidacy
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