Waiver of Liability for International Travel
Orange County Community College (SUNY Orange) is a public educational institution. References to the College
(“College”) include its officers, officials, volunteers, students, agents and assigns. I
freely choose to participate in the (henceforth referred to as the “Program”). In consideration of my participation
in this Program, I hereby agree to the following terms and conditions:
1. I am an adult, 18 years of age or older. If I am not 18 years of age, or older, I have obtained the written
permission of my parent(s) or legal guardian to participate in this Program.
2. I understand and acknowledge that travel entails various risks, including the risk of injury to or loss of
property, personal injury, and, in the worst case, death, whether from illness, accident, terrorism, war or
other causes. To the extent this Program involves foreign travel, I also understand that travel advisories
are available from the U.S. State Department by calling 202-647-5225, or on the Internet at
3. I understand and agree that I am responsible for arranging my own health, accident, and liability
insurance. I state that there are no health-related reasons or problems that preclude or restrict my
participation in this Program. I have obtained the required immunizations, if any.
I recognize that the College is not obligated to attend to any of my medical or medication needs, and I
assume all risk and responsibility therefore. In case of a medical emergency occurring during my
participation in this Program, I authorize in advance the representative of the College to secure whatever
treatment is necessary including the administration of an anesthetic and surgery. The College may (but is
not obligated to) take any actions it considers to be warranted under the circumstances regarding my
health and safety. I agreed to pay all expenses relating thereto and release the College from any liability
for its actions.
4. I understand that Orange County Community College cannot make available to me, my family, or my heirs
and assigns, promises or guarantees with regard to my health and safety as a result of my participation in
this Program.
5. As a condition of my participation in this Program, I understand and agree that I am hereby waiving any
and all claims arising out of, or in connection with my travel to and from, and/or my participating in the
Program, that I, my family, my heirs or my assigns may otherwise have against Orange County Community
College and/or its personnel.
6. I understand that the College is not an agent of, and has no responsibility for, any third party which may
provide any services including food, lodging, travel, or other goods or services associated with this
Program. I further understand the College is not responsible for matters that are beyond its control. I
acknowledge that the College reserves the right to cancel the trip without penalty or to make any
modifications to the itinerary and/or Academic Program as deemed necessary by the College.
7. I understand that the College is not responsible for any loss or damage I may suffer when I'm traveling
independently or I am otherwise separated or absent from any College activity. In addition, I understand
that any travel that I do independently on my own, before or after the College-sponsored Program, is
entirely at my own expense and risk.
8. If I become separated from the Program group, fail to meet a departing airplane, bus, or train, or become
sick or injured, I will, to a reasonable extent, and at my own expense seek out, contact, and reach the
Program group at its next available destination.
9. Knowing the risks described above, and in voluntary consideration of being permitted to participate in the
Program, I agree to release, indemnify, and defend the College and its officials, officers, employees,
agents, volunteers, sponsors, and students from and against any claim which I, the participant, my
parents or legal guardian or any other person may have for any losses, damages or injuries arising out of,
or in connection with, my participation in this Program.
10. Please check one of the following:
_____ I have purchased trip insurance.
_____ I have been informed that it would be advisable to purchase trip insurance. However, I
have chosen not to purchase such insurance and agree to hold Orange County
Community College harmless in the event my trip is canceled or the tour provider fails to
meet their obligation as advertised.
11. I will follow the Orange County Community College Student Code of Conduct while participating in this
activity. I will not possess or use alcohol or unlawful substances while I am participating in this activity.
12. I indicate by my signature below that I have read the terms and conditions of participation and
agreed to abide by them. I have carefully read this release form and acknowledge that I understand it. No
representation, statements, or inducement, oral or written, apart from the foregoing written instrument,
have been made. This release form shall be governed by the laws of the State of New York, which shall be
the forum for any lawsuit filed under or incident to this release form, or to the Program. If any portion of
this release form is held invalid, the rest of the documents shall continue full force and affect.
Participant/Student (Print Name) Participant/Student (Signature) Date
Signature of Parent or Legal Guardian Date
(If student is a minor)
Emergency Contact Information
Name Telephone #
Relationship Address
Rev. August 2013