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THE CONSENT AND RELEASE AGREEMENT The following agreement is designed to protect all
participants in American University's study abroad program, known as EUROPE 2005 Summer Program (JLS-551-01, Summer 2005), including
students, faculty members, The American University, and the agencies and
individuals cooperating with the University.
You, as the student, must sign this form to indicate agreement with provisions
and permission to participate. NAME OF PROGRAM: EUROPE
2005 JLS 551-N01 SEMESTER/YEAR: SUMMER
2005 PROGRAM DATES: May
10- 1. General Release:
I understand that participation in the EUROPE 2005 Program (The Summer Program; The Program) is entirely voluntary and that
any program of travel involves some element of risk, including travel to, from,
and within I agree that, in partial consideration of American
University sponsoring the Summer Program and permitting the student to
participate, I (including my parents, guardians, and legal representatives)
shall not attempt to hold American University, its trustees, officers,
employees, faculty, agents, and co-sponsoring institutions and their agent(s)
liable for any injury, death, or loss to person or property sustained by me
while participating in or arising out of any travel or activity conducted by or
under the auspices of American University's ("University") Summer
Program. I am fully aware that this release includes also all of my
travel arrangements. I have been
informed that they are my sole responsibility.
The University, its trustees, officers, employees, faculty, agents, and
co-sponsoring institutions and their agent(s) are not liable in any way for any
type of injury, death or loss that I might suffer as a result of those
arrangements. I also understand that I am fully responsible for any
travel, hotel, and subsistence expenses incurred before and/or after the
official dates of the Summer Program. I
am also responsible for any damage or other claim by hotels, transfer buses,
and any other institution and business raised against me and/or
class-roommates. 2. Program Changes or
Termination: I understand that the University reserves the right to make
cancellations, changes, or substitutions in cases of emergency or changed
conditions in the interest of the
group. Should the University cancel the
Summer Program, full refunds of tuition and program fees will be made unless
the cancellation is due to circumstances beyond the control of the University
in which case the University will be able to refund only uncommitted and/or
recoverable funds. I understand that any refunds made for the Summer Program
where payment is made to the University will be in accordance with published
University policies for the academic year in which the Program occurs, unless
otherwise stated. I am aware of the penalties for withdrawal from the program after 3. Insurance Coverage: I understand that
the University provides all participating students with appropriate accident
and medical insurance. Students are
personally responsible for filing reimbursement claims or other claims with the
insurance provider and for providing any documentation required. The University requires students planning to operate a
motor vehicle overseas to obtain liability and collision insurance that will
cover them in the applicable foreign countries.
The University recommends that students insure their personal property
from loss or theft. 4. Medical Treatment: I understand that while I am overseas an emergency may
develop which necessitates medical care, hospitalization, or surgery. Wherever possible, a Summer Program
representative or agent will contact the person whom I have designated on my
application forms prior to such treatment.
However, this may not be practical depending upon the nature of the
emergency. Therefore, I authorize the
University, through any of the faculty members participating in the Summer
Program, to secure any necessary emergency medical treatment, including the
administration of anesthesia and surgery.
I understand that such treatment shall solely be at my expense and I
agree to reimburse the University for any expenses, which it may incur on
account of my injury or treatment. I further agree that I (including my parents, guardians, or
legal representatives) shall not attempt to hold the University, its trustees,
officers, employees, faculty, agents, and co-sponsoring institutions and their
agent(s) liable for any injury or death sustained by me in connection with any
medical care, hospitalization, or surgery I undergo while participating in the
Summer Program. 5. Voluntary or
Involuntary Withdrawal or Dismissal:
I understand that all students are subject to University regulations, Program
guidelines, and laws of the host countries.
In the event of violation of these, academic failure, or behavior which
is detrimental to other students of the Summer Program, the Director of the
Program shall have the right to dismiss me from the Program. The Director’s decision will be final and may
result in the loss of academic credit and Summer Program fees. I
agree to pay for all costs arising out of my voluntary or involuntary
withdrawal from the Summer Program prior to its completion for whatever reason,
including withdrawal caused by illness or disciplinary action, as set forth
above. I agree that I (including my
parents, guardians, or legal representatives) shall not assert claims for or
hold the University, its trustees, employees, officers, faculty, agents and
co-sponsoring institutions and their agents responsible for any costs or losses
resulting from said events. 6. Pledge:
I agree to comply fully with the rules of the University, its agents, and/or
any travel facilities. I agree that the
University has the right to enforce its standards of conduct and that, should I
fail to comply with them, the University has the right to terminate my
participation in the Summer Program with no refund of monies paid. I further agree that the policies of the
University and of the travel facilities, if any, may be applied to me as a
participant and that the University shall have the right to exercise the
policies of the University or the travel facilities. I HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS AND AGREE
TO BE BOUND BY THEM AS INDICATED BY MY SIGNATURE BELOW. Printed Student Name: ____________________________________________ Student Signature: ____________________________________________ Student Identification Number or Social Security Number: ____________________________________ Date: _____________________________________ Return the application form, deposit and consent/release
form to: Prof. Emilio Viano/Europe 2003 DJLS/SPA, Tel. 202 885 2953 or 202-885-6228; FAX 202 885 2907; eviano@american.edu Preferred e-mail address for program inquiries: europe@american.edu Preferred phone number for inquiries: (202) 885-6228 |