Assumption of Risk for Travel Abroad
ASSUMPTION OF RISK AND RELEASE FROM LIABILITYKentucky Community and Technical College System? Student ? Employee or ? Volunteer International Travel (please check the appropriate box)___________________________________________________________________________________Name: LastFirstMiddle Initial________________________ _________________Student or Employee ID number Date of Birth________________________________________________________________________Academic Program NameFaculty Sponsor NameSponsor College NameDestination(s): _____________________________Date(s) of Travel: __________ to ___________City/Town, Country mm/dd/yy mm/dd/yy _____________________________ __________ to ___________ _____________________________ __________ to ___________By signing this document, I agree to the following:1. Risk of Travel Abroad: I understand that the travel listed above is not required as part of any course or degree program in which I am enrolled or as a condition of current or future employment and involves risks that are not found in study, volunteer work, or employment at my home college. I understand that certain risks are inherent in any foreign travel experience and I fully accept those risks. These risks may include, but are not limited to, such things as war, quarantine, civil unrest, public health risks, criminal activity, terrorism, exposure to communicable diseases, ill effects of unfamiliar food and water, incidents related to ground, air or water transportation, adverse weather conditions, accident, injuries or damage to property, and other physical, mental, and emotional injury. a. I understand that KCTCS is requiring me to familiarize myself with information about the location I am traveling to, including the current travel warnings and consular information sheets issued by the US Department of State () and the most current health warnings from the US Centers for Disease Control and Prevention, () which may contain information about the inherent dangers and difficulties of the destination. I understand that by providing any information related to this travel, KCTCS is not recommending or endorsing travel or study to any country covered by a U.S. Department of State Travel Warning or CDC Warning Level 3. b. In cases where the US State Department has issued a Travel Warning to the country or region listed above, I acknowledge that I have read and fully understand this warning. I am proceeding with my travel plans notwithstanding this State Department Warning or CDC Warning Level 3 and suggestion made to me by KCTCS officials that I defer this travel until a lower level of alert for this destination is reinstated by the U.S. Department of State or CDC;c. I understand that the Travel Warning represents the US Government’s determination that there is an increased level of risk associated with travel to this destination;d. I understand KCTCS may find it necessary to cancel the travel if the security situation worsens after money has been paid or after travel has begun;e. It is crucial that I obey all directives of KCTCS, maintain close communication with the Faculty Sponsor (if applicable), on-site staff, and my colleagues and classmates, and exercise due caution and common sense in my behavior, actions, choices, activities, locations visited, etc. while traveling;f. I understand that the US government and KCTCS may not be able to provide me with any legal, medical, or emergency assistance while traveling in the counties listed above;2. Independent Activity: If I am traveling with a group, I agree to leave the country I am visiting with the group at the conclusion of the program. I understand that, in addition to the other provisions of this agreement, KCTCS is not responsible for any injury or loss I may suffer when I am traveling independently or am otherwise separated or absent from formal program activities supervised by KCTCS.3. Health and Safety: I am aware of and solely responsible for all applicable personal medical needs. I understand I am responsible for payment for any and all medical costs incurred by me while traveling. I recognize that KCTCS is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility for meeting those needs. If I require medical treatment while traveling, KCTCS is not responsible for the cost or quality of such care or treatment, or injuries arising from or related to such care. I have consulted with my health care provider regarding this travel, and there are no health-related issues that would prevent my participation in the program.4. Standards of Conduct: a. I understand that each country has its own laws and standards of acceptable conduct, including dress, manners, morals, politics, drug use, and behavior. I recognize that behavior that violates those laws or standards could pose a threat to my own health and safety, and could also harm KCTCS’ relationships with those countries and the institutions therein. I understand KCTCS is not responsible for providing any assistance, legal or otherwise, in dealing with the laws or standards of foreign countries. It is my personal responsibility to become aware of such laws and standards and I accept the consequences should I commit any violation thereof.b. I agree to comply with KCTCS’ rules, standards, and instructions for behavior while traveling. I waive and release all claims against KCTCS, its Regents, employees, agents, and cooperating institutions and their offices and agents (if any) [hereinafter “Indemnified Parties”], that may arise at such times that I am not under the direct supervision of KCTCS or that are caused by my failure to remain under supervision or to comply with the rules, standards, and instructions provided. I understand that engaging in research activities or taking research samples from a foreign country without obtaining proper authorization, which may include permits, may result in monetary penalties or prison in that country.c. I agree that KCTCS has the right to enforce the standards or conduct described above, in its sole judgment, and that it will impose sanctions, up to and including expulsion from the travel and/or the college, for violating these standards or for any behaviors detrimental to or incompatible with the interest, harmony, and welfare of KCTCS, other participants, or third parties. I understand that due to the circumstances of travel abroad programs, procedures for notice, hearing, and appeal applicable to disciplinary proceedings at my home college do not apply. If I am expelled from the trip, I understand that I will be sent home at my own expense with no refund of costs.5. College Use of Participant Information: I authorize KCTCS to release information about my participation in the travel activity, particularly in the event of health or safety matters. I also authorize KCTCS to use my name and likeness, in any form, in any advertising, publicity, or promotion, or for other valid business purposes, without additional permission or any compensation, in perpetuity.6. Assumption of Risk and Release of Claims: I fully understand the above risks involved in the proposed travel and I agree to assume the risks of this travel, including the risk of catastrophic injury or death. Knowing these risks and in consideration of being permitted to participate in the travel program, I agree, on behalf of my family, heirs, and person representative(s), to indemnify, hold harmless, release and forever discharge all Indemnified Parties from any and all present or future claims and expenses, including reasonable attorney's fees, for any injury, loss, or damage to person or property, including catastrophic injury or death, suffered by me, or for which I may be liable to any other person, related to the travel described above (including periods in transit to or from any country that is part of this travel). I, or in the case of a minor, my parent and/or legal guardian, have carefully read this Assumption of Risk and Release before signing it, and have had the opportunity to have it reviewed by my own counsel. No representations, statements, or inducements, oral or written, apart from the foregoing statement, have been made.________________________________________ _____________________________ Signature of Applicant or Parent/GuardianPrinted Name of Signatory__________________ _______________________ Date Student/Employee ID# ................
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