Participant Travel/study Program Release Of Liability Form printable pdf download

PARTICIPANT TRAVEL/STUDY PROGRAM

Release of Liability Form

I, __________________________________(print clearly), hereby agree to participate in

the Shenandoah University Travel/Study Program.

Destination(s) Abroad: ________________________________________________

Inclusive Dates:______________________________

In making this agreement, I understand that

1. My participation is completely voluntary and is not required:

2. I bear full legal and financial responsibility for myself, including responsibility for

all indebtedness or other legal obligations incurred by me while on this tour.

3. All pertinent policies of Shenandoah University will apply;

4. Shenandoah University reserves the right to require my withdrawal from the tour

if it is determined that my continuation would be detrimental to myself, to

others, or to the University. Return passage and any other expenses due to such

involuntary withdrawal are to be defrayed by me.

5. My presence in another country exposes me to risks of physical and emotional

harm that I may not be exposed to on the Shenandoah campus.

6. As a participant I will be subject to the laws of the destination countries.

7. Shenandoah University is neither the only nor the best source of information

regarding safety conditions abroad. It is my responsibility to check the latest

U.S. State Department assessment of the travel risks involved in the areas where

we will be traveling and to decide whether or not I will participate in the

Travel/Study Program ( ).

I agree:

To release Shenandoah University and its officers, employees, agents and representa-

tives from any and all claims, demands and causes of action whatever arising out of my

participation in this Travel/Study Program, including but not limited to: loss of property,

illness, personal injury or death suffered by myself.

I certify that I have read the above provisions of this Release of Liability

Form, understand them, and agree to be legally bound by them.

_______________________________________

________________

Signature of Participant

Date

__________________________________________

________________

Signature of Parent or Legal Guardian

Date

(Required for dependent participants)

hTravel/StudyTravel Abroad-Release of Liability-02

(revised 2-21-02)

Participant Travel/study Program Release Of Liability Form