General Release Assumption Of Risk And Waiver Of Liability
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1General Release, Assumption of Risk and Waiver of Liability
I, _______________________, acknowledge that I am aware that there are risks to me of injury
entailed in my participation in this Program, including the risks of travel to and
from ___________________________, as well as the risks associated with residing in a foreign country
whose level of health care and social services may differ from those in the United States. These risks
include, but are not limited to, crime, terrorism, war, exposure to communicable diseases, serious bodily
injury or death, property damage and other risks that may not be foreseeable. I fully and completely
assume any risks solely to myself, and accept full responsibility for my individual physical fitness to
participate in this Program and its activities. I acknowledge that it is my responsibility to review the
Program and its requirements and to request further information if needed to make a proper participation
decision. I understand that Boston University does not control or run any aspect of the Program, and the
University gives no assurances or warranties whatsoever as to the safety of participants in this Program.
In consideration of my participation in the Program and in acknowledging that I am aware of and
willing to assume the risks associated with participating in the Program, I, on behalf of myself, my
family, heirs, and personal representatives, hereby voluntarily agree to defend, release, hold harmless and
indemnify Trustees of Boston University and its trustees, agents, volunteers and employees from any and
all liability, claims, demands, damages and causes of action of any nature whatsoever arising, including
claims arising out of negligence, which I, my heirs, my assigns or successors may have against them for,
on account of, or by reason of my participation in Program.
I agree that this instrument shall be governed by and construed in accordance with the laws of the
Commonwealth of Massachusetts excluding those laws that direct the application of the laws of another
jurisdiction, and shall be binding upon my legal representatives, heirs, executors, administrators,
successors and assigns. I hereby consent to the exclusive jurisdiction and venue of the state and federal
courts located in Boston, Massachusetts with respect to any claim, suit or action arising in any way out of
this instrument or the subject matter thereof.
I, or my parent/legal guardian if I am under age 18, have read and understand the content of this
document, and execute this GENERAL RELEASE, ASSUMPTION OF RISK and WAIVER OF
LIABILITY AGREEMENT freely and voluntarily.
To certify that all of the information in your application is accurate and true, please provide the date, and
print and sign your name in the space provided below.
Sign Name: __________________________________
Print Name: __________________________________
Date: ________________________
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