STSA Assumption of Risk & Release of Liability
This required form for faculty and staff leading short-term programs abroad is a release of legal rights. Please be certain you read and understand this release before signing. Signer has the right to seek an attorney's review before signing.
DISCLAIMER: This form must be completed in one sitting as information cannot be saved.
In consideration of Participant (myself) being permitted to participate in the Program, and by my signature below, I agree, represent and certify as follows:
1. Risk Assessment. I have carefully identified, reviewed and considered the risks of travel to each Program-related destination, including by reading:
a. each most recent relevant U. S. State Department Travel Warning available through http://travel.state.gov; and
b. the University’s Travel Warning Policy dated December 10, 2008 listed on the Faculty Resources section of the International Center website.
2. Risk Management.
a. Definitions. i. “Harm” means any injury or illness (including death) that Participant sustains or experiences that is caused by, derived from, or associated with the Program. ii. “Representative” means Participant’s heir, executor, administrator or assign. iii. “UH” means the University, its employees, officers, regents and agents.
b. Precautions: I have or will secure health insurance to provide adequate coverage for any Harm. I have confirmed that Participant’s health care coverage will adequately cover Participant while outside the United States. I release on behalf of myself and each Representative UH from any responsibility or liability for any expense for any Harm.
3. Program Changes. I understand that, although the University will attempt to maintain the Program as described in its publications and brochures, it (or any University-engaged Program affiliate) reserves a right at any time and without notice to cause or permit a change to the Program or any Program activity. UH is not responsible for any expense or loss that Participant sustains because of that change.
4. Removal. I understand that the University reserves a right to remove Participant from the Program at any time if the University considers any action or general behavior by Participant to impede or obstruct the Program’s progress.
5. Release. I understand that unavoidable risks exist in study and travel outside the United States. I – on behalf of Participant, myself and each Representative – release and promise not to sue UH for any Harm, except for any damage or injury that any gross negligence of willful misconduct by UH causes. This release binds any member of Participant’s family and any spouse of Participant if Participant is alive, and each Representative if Participant is deceased, and I consider this Agreement to comprise a release, waiver, discharge, and covenant not to sue UH.
6. Severability. If a tribunal of competent jurisdiction finds any provision or aspect of this Agreement to be unenforceable, then all remaining Agreement provisions remain in full force and effect.
7. Legal Review. My acceptance of this Agreement is wholly voluntary. I understand that, prior to signing this Agreement, I have a right to consult with any advisor, counselor, or attorney of my choice.
8. Governing Law; Venue. If any dispute arises concerning Participant’s Program participation that requires adjudication of a court of law, such adjudication must occur in the courts of, and be determined by the laws of, the state of Connecticut.
9. Entire Agreement. This Agreement represents my complete understanding with the University concerning the University’s responsibility and liability for Participant’s Program participation, and supersedes any previous or contemporaneous written or oral understanding that I may have had with the University on this subject, and cannot be changed or amended in any way without Participant's written concurrence.
Leader's Electronic Signature:
Leader's Status Relative to University:
Faculty, Staff, etc.
Example: March 17-25, 2018
Do Not Fill This Out