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Waiver and Release Agreement

 

INTERNATIONAL FIELD TRIP OF THE OFFICE OF FIELD SERVICES PROGRAM

(CLARION UNIVERSITY OF PENNSYLVANIA)

(COLLEGE OF EDUCATION AND HUMAN SERVICES)

WAIVER AND RELEASE AGREEMENT


            I, ________________________________________________, am a student at Clarion University of Pennsylvania (the University) and have agreed to participate in the ____________________________program in ___________________________from ______________________until ______________________(the Program).  In consideration for being permitted to participate in the Program, I hereby agree and represent that:

  1. I have or will secure health insurance to provide adequate coverage for any injuries or illnesses that I may sustain or experience while participating in the Program.  By my signature below, I certify that I have confirmed that my health care coverage will adequately cover me while outside the United States, and hereby release the Board of Governors of the State System of Higher Education, the State System of Higher Education, the Commonwealth of Pennsylvania, the University, the employees and agents of these counties, from any responsibility, or liability for expenses incurred by me for injuries or illnesses, (including death) that I may incur because of those injuries or illnesses.

  2. I understand that, although the University will attempt to maintain the Program as described in its publications and brochures, it reserves the right to change the Program, including the itinerary, travel arrangements, or accommodations, at any time and for any reason, with or without notice, and that the Board of Governors of the State System of Higher Education, the State System of Higher Education, the Commonwealth of Pennsylvania, and the University, or the employees and agents of these entities, shall not be responsible or liable for any expenses or losses that I may sustain because of these changes.

  3. I understand that, although the University has made every reasonable effort to assure my safety while participating in the Program, that there are unavoidable risks in travel overseas, and I hereby release and promise not to sue the Board of Governors of the State System of Higher Education, the State System of Higher Education, the Commonwealth of Pennsylvania, or the employees  and agents of these entities, for any damage or injury (including death) caused by, deriving from, or associated with my participation in the Program.

  4. I agree that, should any provision or aspect of this agreement be found to be unenforceable, that all remaining provisions of this agreement will remain in full force and effect.

  5. I represent that my agreement to the provisions herein is wholly voluntary, and further understand that, prior to signing this agreement, I have the right to consult with the adviser, counselor, or attorney of my choice.

  6. I agree that, should there be any dispute concerning my participation in the Program that would require the adjudication of a court of law, such adjudication will occur in the courts of, and be determined by the laws, of the Commonwealth of Pennsylvania.

  7. This agreement represents my complete understanding with the University concerning the University?s responsibility and liability for my participation in the Program, supersedes any previous or contemporaneous understandings I may have had with the University on this subject, whether written or oral, and cannot be changed or amended in any way without my written concurrence.

  8. I represent that I am at least eighteen years of age.  I acknowledge that I have read this Waiver and Release Agreement, understand its contents, and that I am legally bound hereby and acknowledge that it is signed freely, voluntarily, and under no compulsion.

 

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STUDENT (please print)

 

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STUDENT (signature)                                                                                    Date