Study Abroad Release And Waiver Of Liability Form (Page 2 of 3) in pdf

Study Abroad Release And Waiver Of Liability Form Page 2

I have made the decision to participate in the program despite any warning or advisory

regarding travel to that country.

I agree to participate in any orientation required for the program; to pursue the

necessary steps to obtain authorization to practice medicine in the country in which the

program will be held if my participation in the program requires such authorization; and

to obtain medical travel advice and immunizations appropriate for any country in which

travel is planned.

I understand that the University of Pennsylvania, including the School of Medicine,

accepts no responsibility for any delay, loss, damage or injury to person or property caused

to others or me whether prior to departure, during travel or while participating in the

program abroad. Further, the University shall not be responsible to any person for any of

my acts or omissions, except to the extent that my activities are within the scope of

approved activities covered under the University’s general liability insurance.

I agree to hold harmless, release and forever discharge the University and its trustees,

officers, employees and agents from any and all claims, demands and causes of action of

whatever kind that I may have including, but not limited to, illness, bodily injury,

imprisonment, death and loss or damage to property, or the consequences thereof,

resulting from or in any way connected with my participation in the program.

My participation in this program is voluntary, and I freely agree to the stipulations of

this waiver. By signing below, I certify that I am at least 18 years of age and that I have

carefully read this Release and Waiver of Liability, understand it, and agree to be legally

bound by it.

_________________________________

Date: ___________________

Signature

Print Name: _______________________

Name of Program_________________________________________________________

Country of Program_________________________________

Please return this form to the Office of Academic Programs, School of Medicine, University of

Pennsylvania.

Study Abroad Release And Waiver Of Liability Form Page 2