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Carm-d-6625-release-of-liability-waiver-2018 - CARM-D 6625 Release of Liability Waiver 2018

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Summer 2018
CARM/D 6625
1
RELEASE OF LIABILITY AND ASSUMPTION OF RISKS
THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISKS (the "Release") is executed by
__________________________________________________(insert name) identified by the following N
number____________(insert N number) (only if the person has an N number) whose address is
______________________________________________________________ (insert address) in favor of
NOVA SOUTHEASTERN UNIVERSITY, INC., a Florida not for profit corporation (the "University"),
whose address is 3301 College Avenue, Fort Lauderdale, Florida 33314.
1. PARTICIPATION IN THE TRIP: I desire to participate in a trip to Ecuador (hereafter referred
to as the “Destination”) scheduled to occur from ___________________(insert dates of travel) for
the primary purpose of CARM/D 6625 – Global Field Studies Practicum in Conflict Resolution
offered by Nova Southeastern University’s Department of Conflict Resolution Studies, College of
Arts, Humanities and Social Sciences and acknowledge that I am not required as part of my
academic program or otherwise to participate in the Trip.
2. WAIVER OF UNIVERSITY LIABILITY FOR DANGERS AND RISKS: I understand that
there are certain dangers, hazards, and risks inherent in U.S. and international travel and the
activities to be engaged in during the Trip including, but not limited to, those set forth in EXHIBIT
"A" attached hereto and made a part hereof, which can cause personal injury, death and property
damage. I further understand that the University cannot and does not assume any liability or
responsibility for any such personal injury, death or property damage. I am participating in the
Trip on a voluntary basis and have not been induced to do so by the University or any other person.
3. ASSUMPTION OF RISKS: Notwithstanding the dangers, hazards, and risks involved, and in
consideration of being permitted to participate in the Trip:
(i) I knowingly and freely agree to assume all the risks, both known and unknown,
surrounding my participation in the Trip and in the activities I undertake in connection
therewith; and
(ii) I release and forever discharge the University, its trustees, officers, agents, employees, and
any students acting as employees (hereafter collectively called the "Releasees"), from any
and all liability for any injury, damage, claim, demand, action, loss, liability, cost and
expense (including, without limitation, reasonable attorney’s fees) of any nature that I may
at any time have or incur, arising out of or in any manner related to any loss, damage,
injury, or disability including but not limited to suffering and death, that may be sustained
by me or by any property belonging to me, while in the Destination or in transit to and from
the Destination.
4. DISCLAIMER OF UNIVERSITY RESPONSIBILITY: I understand and agree that the
University and Releases are:
(i) not responsible or liable for any injury, damage, loss, accident, delay or death or other
wrongful act of any party engaged to provide services connected with the Trip,
Summer 2018
CARM/D 6625
2
(ii) not responsible or liable for any injury, damage, loss or expense due to sickness, weather,
strikes, hostilities, wars, natural disasters, terrorism, or other such causes,
(iii) not responsible or liable for disruption of travel arrangements, or any consequent additional
expenses that may be incurred therefrom, and
(iv) not responsible or liable for any loss, damage, or theft of my luggage or other personal
belongings.
5. RESPONSIBILITY FOR MEDICAL NEEDS: I represent to the University that I am aware of
my personal medical needs and that there are no health-related reasons or problems that preclude
or restrict my safe participation in the Trip. I acknowledge that the University has strongly
recommended that I obtain insurance coverage valid in the Destination to protect against the cost
of hospitalization and physician care in the event of sickness, accident, injury and disability. I
understand that I am solely responsible for obtaining such insurance (may be included with the
collaborating agency). I further understand and agree that (i) the University is not responsible for
attending to any of my medical or medication needs; (ii) I assume all risks and responsibility for
my medical and medication needs; and (iii) if I am required to be hospitalized at any time during
the Trip, the University does not assume any legal responsibility for payment of such costs.
6. EMERGENCY MEDICAL TREATMENT: I understand that the University does not have
medical personnel available at any time during the Trip. I grant the University permission to
authorize emergency medical treatment, including surgery, and I agree that such action by the
University shall be subject to the terms of this Release. I understand and agree that the University
assumes no liability or responsibility for any injury or damage that might arise out of or in
connection with such authorized emergency medical treatment.
7. LEGAL PROBLEMS: I understand that if I have a legal problem in the Destination during the
Trip, I will attend to the matter personally with my own funds and that the University is not
responsible for providing any assistance to me under such circumstances.
8. BINDING NATURE OF RELEASE: It is my express intent that this Release shall bind the
members of my family (including my spouse, if any) if I am alive, and my heirs, personal
representatives, successors, and assigns if I am deceased.
9. INDEMNIFICATION: I agree to indemnify, defend and hold the Releasees harmless from any
liability, claim, action, damage, loss, fine, penalty, cost or expense, including, without limitation,
reasonable attorney’s fees, of every kind or nature asserted by any party against any Releasee or
incurred by any Releasee and arising directly or indirectly from or in connection with my
participation in the Trip or any of the activities I engage in during the Trip
.
10. RESERVATION OF RIGHTS: I acknowledge that the University reserves the following rights
that it may exercise in its sole discretion: (i) the right to cancel the Trip, and (ii) the right to make
alterations, changes, and modifications in any part of the Trip itinerary and the activities in
connection therewith.
11. PASSPORT, VISA AND VACCINATIONS: I understand that I am responsible for obtaining
Summer 2018
CARM/D 6625
3
my own passport, visa and public health vaccinations.
12. COMPLIANCE WITH LAWS: I agree to comply with all laws of the Destination during the
Trip.
13. DISCLOSURE: THE UNIVERSITY HAS INFORMED ME THAT BY SIGNING THIS
DOCUMENT I RELEASE AND WAIVE CERTAIN LEGAL RIGHTS THAT I
OTHERWISE MIGHT HAVE, AND THAT I SHOULD READ THE DOCUMENT
CAREFULLY AND UNDERSTAND IT FULLY BEFORE SIGNING.
14. REPRESENTATIONS: I REPRESENT TO THE UNIVERSITY THAT (i) I HAVE READ
THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS AND THE EFFECT OF
ITS TERMS AND PROVISIONS, (ii) I SIGN THIS RELEASE AS MY OWN FREE ACT
AND DEED, (iii) WITH RESPECT TO THE MATTERS SET FORTH IN THIS RELEASE,
NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS OTHER THAN
THOSE EXPRESSLY CONTAINED HEREIN HAVE BEEN MADE TO ME BY ANY OF
THE RELEASEES, (iv) I AM OVER EIGHTEEN (18) YEARS OF AGE AND FULLY
COMPETENT TO SIGN THIS RELEASE AND (v) I EXECUTE THIS RELEASE FOR
COMPLETE AND ADEQUATE CONSIDERATION, FULLY INTENDING TO BE
BOUND BY THE SAME.
15. GOVERNING LAW: I agree that this Release shall be construed in accordance with the laws of
the State of Florida.
16. PARTIAL INVALIDITY: If any term or provision of this Release shall be held by a court of
competent jurisdiction to be illegal, unenforceable, or in conflict with any law governing this
Release, then I agree that all remaining terms and provisions shall not be affected thereby.
____________________________________________
Participant Name
____________________________________________
Participant Signature
_____________________________________________
Date
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Summer 2018
CARM/D 6625
4
EXHIBIT “A”
If international travel only or international and US travel
Problems and hazards that participants can experience.
1. Poor quality food or drinking water.
2. Food poisoning.
3. Circumstances of travel via plane, bus or other means of
transportation.
4. Theft.
5. Natural events, e.g. earthquakes, tropical storms, hurricane, volcanic activity,
etc.
6. High altitude nausea, nose bleeds, headaches.
7. Drug availability and severe police/legal penalties.
8. Political instability.
9. Kidnapping, torture and death.
10. Guerrilla warfare.
11. Violence relating to drugs.
12. Terrorist activity of any kind.
13. Unforeseen illnesses.
14. And any other unforeseen circumstance that can cause injury, death or
damage to property.
Summer 2018
CARM/D 6625
5
EXHIBIT “A”
If US travel only
Problems and hazards that participants can experience.
1. Food poisoning.
2. Circumstances of travel via plane, bus or other means of
transportation.
3. Theft.
4. Natural events, e.g. earthquakes, tropical storms, hurricane, volcanic activity,
etc.
5. Drug availability and severe police/legal penalties.
6. Violence relating to drugs.
7. Unforeseen illnesses.
8. And any other unforeseen circumstance that can cause injury, death or
damage to property.
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Carm-d-6625-release-of-liability-waiver-2018 - CARM-D 6625 Release of Liability Waiver 2018

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Completed 17 November 2019

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