PARTICIPATION AGREEMENT AND CONSENT AND ACKNOWLEDGEMENT by acm63157

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									                                    International Travel Approval Policy

                             PARTICIPATION, CONSENT, RISK & RELEASE
                           FOR STUDENTS TRAVELING INTERNATIONALLY

This Participation , Consent, Risk & Release Form is the legally binding contract between The George

Washington University and ________________________________________________________________.
                                                                  (Name of Student)

This student is participating in _____________________________________________________________
                                                                  (Name/Sponsor of Program)

in _____________________________________________ during ___________________________________.
                         (Location Abroad)                                         (Term Abroad – e.g., Spring 2009)

                                       CONDITIONS FOR PARTICIPATION

The undersigned is a student approved by GW to travel internationally for a University-sponsored or University-related
event. The undersigned understands that he or she must register with International SOS and submit this form to the
Office of International Programs prior to departure. The undersigned acknowledges that he or she is not required to
travel to the destination in order to satisfy any University requirement, and that such travel is wholly voluntary.

A. Behavioral Responsibilities: The undersigned is aware of the expected behavioral responsibility while traveling
internationally. As a guest in a foreign country, there are certain behaviors which are considered unacceptable and could
lead to possible disruption of the program. The undersigned hereby assures the University that he/she shall conduct
himself/herself in an appropriate manner which does not infringe upon the rights and safety of customs and mores of the
country in which the program is being conducted, nor upon the rights and safety of the undersigned and of other
participants in the program. Behavioral responsibilities shall be applicable during the course of the program both when
in the company of other program participants and when the undersigned is physically separated from other program
participants. In addition, the undersigned must adhere to all policies outlined in The GW Student Code of Conduct.
Inappropriate behavior is cause for immediate dismissal from the program without refund.

    The undersigned agrees to abide by all rules and regulations established by GW, and all laws, regulations and
    policies of GW, the District of Columbia, the United States of America, and the country or countries visited as a part
    of the program listed above. The most stringent will apply.

        Illegal Drugs: The undersigned understands that the use or possession of drugs which are illegal in the US or
        host country during the program or being knowingly present in instances of use or possession of such illegal
        drugs during the program is cause for immediate dismissal from the program without refund.

        Involuntary Withdrawal: The undersigned acknowledges that return passage and all other expenses occasioned
        by a participant’s involuntary withdrawal from the program shall be the sole and exclusive financial
        responsibility of the student concerned.

B. Medical Responsibility: The undersigned authorizes GW or any of its agents to provide any reasonable, incidental
and/or emergency medical treatment for the participant, in the event of the participant’s illness, injury, or incapacity, and
participant hereby accepts the responsibility to pay for such treatment. The undersigned certifies that he or she is in good
health, may travel as required, and is free from any physical or mental ailment or disability requiring medical, surgical, or
other care or treatment which might endanger the health or safety of the participant or those with whom the participant
may come in contact. The undersigned certifies that he or she will have the necessary quantity of all medication needed
for the duration of the study abroad program and assumes all responsibility for taking said medication as prescribed by
                                                                                                         Updated 10/23/08
his or her physician. The undersigned certifies that he or she has reviewed the Centers for Disease Control and Prevention
(CDC) (http://www.cdc.gov) guidelines and recommendations for travel to the country or countries listed above and has
obtained any and all immunizations required unless contraindicated by a medical condition or guidance from his or her
health care professional.

C. Health Insurance: The undersigned certifies that he or she has travel and health insurance that is valid outside the
United States of America and that the insurance is designed to provide medical coverage, evacuation and repatriation
specifically for students studying abroad.

D. Release from Liability: The undersigned acknowledges that there are certain dangers, hazards, and risks inherent in
international travel and the activities included in the program, which could include serious or even mortal injuries, being
held hostage, and property damage, and the participant, for him or herself and on behalf of participant’s family, heirs,
and personal representative(s), agrees to assume all the risks and responsibilities surrounding participant’s participation
in the Program, the transportation, and any activities undertaken as an adjunct thereto, and in advance release, forever
discharge, waive, and covenant not to sue GW, its governing board, officers, agents, employees, and any students acting
as employees, from and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of
action, costs, and expenses of any nature whatsoever which participant may have or which may hereafter accrue to the
participant, arising out of or related to any loss, damage or injury, including, but not limited to suffering and death, that
may be sustained by participant or by any property belonging to participant, while in, on, upon, or in transit to or from
the country of destination. GW is not responsible for making and paying for travel arrangements related to non-credit
international travel.

E. Indemnification: The undersigned certifies that he or she is physically, mentally, and emotionally capable of
attending and participating in university-supported or university-related international travel; assumes all risk and
financial responsibility for any loss or injury to the participant or others that may occur as a result of the participant’s
negligence or misconduct; and indemnifies and holds GW harmless from and against any and all costs, claims, demands,
charges, liabilities, obligations, judgments, executions, costs of suit and actual attorneys’ fees incurred or suffered by GW
as a result of, or arising out of, the participant’s negligence or misconduct while abroad.

F. Program Cancellation and Withdrawal: The undersigned understands that The George Washington University
reserves the right to delete from, add to or otherwise change its policies or programs without notice.

G. Promotion: The undersigned grants to GW for any purpose connected with promoting the purposes and goals of
GW, but not for commercial exploitation, the right to use the participant’s name, voice, and likeness in any writings,
photographs, films, and recordings of the participant as a result of participating in the program, and any biographical
information submitted by the participant to GW, and to use, reproduce, publish, and distribute the same.

H. Other Terms: This agreement shall be governed by and construed in accordance with the laws of the District of
Columbia. All references to GW in this Agreement include GW’s agents, officers, employees and representatives. This
Agreement shall not be amended, supplemented, or abrogated without the written consent of GW.

I hereby agree to comply with the terms of this participation agreement. I certify that I have read this
document, understand the provisions thereof and agree to be bound hereby.

____________________________________________________                               _______________________________________
Signature of Student                                                               Date

*If student is under the age of 18, the signature of a parent or guardian is required below.

I certify that I have read this form, understand the provisions thereof and agree to be bound hereby.

________________________________________
Name of Parent or Guardian (please print)

____________________________________________________                               _______________________________________
Signature of Parent or Guardian                                                    Date




                                                                                                            Updated 10/23/08

								
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