Study Abroad Release And Waiver Of Liability Form

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STUDY ABROAD RELEASE AND WAIVER OF LIABILITY FORM
Please return this form to the Office of Academic Programs, School of Medicine, University of
Pennsylvania.
In consideration for being allowed to participate in the international educational
experience listed below, I, the undersigned student, acknowledge and agree to the following
conditions.
Although the University of Pennsylvania School of Medicine (“the University”) and/or
the sponsor of the program have taken reasonable steps to provide resources and guidance,
I understand that my participation in the program may expose me to significant risks,
including, but not limited to, crime, terrorism, war, exposure to communicable diseases, the
hazards of travel by airplane, vehicle and foot, serious bodily injury or death, property
damage and other risks that may not be foreseeable. I recognize that the University cannot
guarantee my safety and I understand that I am solely responsible for my safety and I
assume responsibility for all risks associated with my participation in the program.
I know that I am not required to participate in this program in order to satisfy any
requirements of the School of Medicine, even though this experience may be an approved
part of my medical education. Furthermore, I recognize that if I am required to leave the
program before its conclusion or if I decide to leave the program before its conclusion,
there is no guarantee that I will receive any approved academic credit or a refund of any
payment made for study abroad or for credit.
I understand and accept that, as a participant in the program, I am required to
observe the laws of the country in which I will be residing and all academic and
disciplinary regulations in effect at the host institution. I further understand and accept
that while participating in the program I will remain enrolled concurrently as a degree
candidate at the University of Pennsylvania and, as such, I agree to adhere to the
University’s Statement on General Conduct and Code for Academic Integrity. I realize that
violation of the foregoing and/or academic failure or disciplinary disturbances may
constitute grounds for my expulsion from the program and referral of any violations to the
Student Standards Committee.
I am informed that the University strongly recommends that students studying abroad
obtain insurance coverage valid overseas to protect against the costs of hospitalization and
medical care in the event of sickness, accident, disability, or death, and to offset expenses of
unexpected emergency evacuation and repatriation, trip cancellation, or loss of property. I
understand that I am solely responsible for obtaining Travel and Health Insurance for
myself.
I confirm that I have been advised to consult the U.S. Department of State resources
for information regarding travel to the country in which the program will be held and that
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