University of Colorado at Boulder

To: Participants in University of Colorado-administered overseas academic programs

This agreement is intended to preserve the integrity of our programs and to protect from harm all

of the parties involved in the University of Colorado overseas academic programs – the State of

Colorado, the University of Colorado, the University of Colorado system, the faculty,

overseas institutions, agencies, organizations and individuals cooperating with University of Colorado’s Study Abroad Office in the administration of these programs, as well as you

and all of the other participants in those overseas academic programs – in the unlikely event that

an individual participant fails to abide by the rules of and procedures required by the program

and/or disregards the laws of the country in which the program is conducted.

Informed consent and agreement to these conditions (indicated by signing this form and

returning it to the Study Abroad Office at the University of Colorado at Boulder prior to departure) is a required condition of participation for all University of Colorado-administered overseas

academic programs, and for all University of Colorado credit-bearing or course related, or other

University-sponsored overseas travel. If you have any questions concerning this document (or

any pre-departure procedures or forms), consult the orientation and other pre-departure materials

supplied or contact the Study Abroad Office at the University of Colorado.

Agreement/Release Form

I, [PRINT FULL NAME] __________________________________________, have agreed to participate

in an overseas academic program, or a credit-bearing, course related, or other University initiated

overseas activity (hereafter called “the program”) sponsored by the University of Colorado, (hereafter called “the University”), either in collaboration with an international host organization or organizations, or by arrangement of and accompanied by a University of Colorado faculty member, in [NAME OF COUNTRY] ____________________________ from

[START DATE] ___________________ to [END DATE] _________________.

I understand and hereby acknowledge that my participation in the program is wholly voluntary. In

consideration of the University’s agreement to permit me to participate in the program, by my

signature below, I agree to and acknowledge the following:

A. I acknowledge that I am aware that there are risks involved in participation in a study

abroad program and that I am willing to assume those risks.

By my signature below, I certify that I understand and hereby acknowledge that:

1. My participation in the program will require transportation to and habitation in [NAME OF

COUNTRY] ______________________ and may involve my being subject to risks relating to

travel or arising out of program activities, and;

2. I have, as advised by the program’s orientation materials, reviewed the U.S. Consular

Information Sheets and Travel Warnings [contained on the U.S. Department of State

Consular Affairs Internet home page] and the Travelers Health section of the Center for

Disease Control’s Internet page, and by those means, been informed of such risks. I

hereby assume, knowingly and voluntarily, each of these risks and all of the other risks

that could arise out of or occur during my travel to, from, in or around the country in which

this program is located.

Agreement/Release Form

B. I acknowledge that I have appropriate insurance coverage and will disclose preexisting

health issues.

1. By my signature below, I certify that I understand and hereby acknowledge that:

a. The University requires that all students participating in an overseas academic program

be covered by appropriate accident and medical insurance and that the participants be

financially responsible for such expenses. The University may require the purchase of a

health insurance policy specifically approved by the University of Colorado as a

condition of participation in a program;

b. Payment for medical expenses overseas may have to be advanced and reimbursement

sought later from the carrier;

c. The University also requires that participants planning to operate a motor vehicle while

overseas obtain liability and collision insurance that will cover them in applicable foreign

countries;

d. The University also recommends that participants in overseas academic programs insure

their property from loss and theft.

2. By my signature below, I certify that:

a. I am and will be covered for the duration of the program and for any pre- or post-program

travel by a comprehensive health and accident insurance policy which provides coverage

for injuries and illnesses I sustain or experience overseas, and, more specifically, in the

country in which I will be living and/or traveling while on the program;

b. I absolve the University of all responsibility and liability for any injuries (including death),

illnesses, claims, damages, charges, bills and/or expenses I may incur while I am abroad;

c. I agree to report to the University any physical or mental condition I have which may

require special medical attention or accommodation during the program at least sixty (60)

days prior to the starting date of the program.

C. I absolve and release the University from liability for things and events that are beyond its control.

By my signature below, I certify that:

1. I, individually, and on behalf of my heirs, successors, assigns, and personal representatives,

hereby agree to indemnify, defend, hold harmless, release and forever discharge the

University and its employees, agents, officers, trustees, and representatives (in their official

and individual capacities) from any and all liability whatsoever for any and all damages,

losses or injuries (including death) I sustain to my person or property or both, including but

not limited to any claims, demands, actions, causes of actions, judgments, damages,

expenses, and costs, including attorneys’ fees, which arise out of, result from, occur during or

are connected in any manner with my participation in the program and/or any travel incident

thereto.

2. I understand and acknowledge that the University assumes no responsibility or liability, in

whole or in part, for any delays, delayed or changed departure or arrival times, fare changes,

dishonors of hotel, airline or vehicle rental reservations, missed carrier connections, sickness,

disease, injuries (including death), losses, damages, weather, strikes, acts of God,

circumstances beyond the control of the University, force majeure, war, quarantine, civil

Agreement/Release Form

unrest, public health risks, criminal activity, terrorism, expense, accident, injuries, damage to

property, bankruptcies of airlines or other service providers, inconveniences, cessation of

operations, mechanical defects, failure or negligence of any nature howsoever caused in

connection with any accommodations, restaurant, transportation, or other service or for any

substitution of hotels or of common carriers beyond the University’s control, with or without

notice, or for any additional expense occasioned by any of the foregoing. If, due to weather,

flight schedules or other uncontrollable factors, I am required to spend additional nights, the

University will not be responsible for my hotel, transfers meal costs, or other expenses. My

baggage and personal property are transported at my risk entirely.

3. The University is not responsible for penalties assessed by air carriers that may result due to

operational and/or itinerary changes, regardless of whether the University makes a flight

arrangement. Any additional expense resulting from such operational and/or itinerary

changes will be paid by me;

4. I release the University, its officers, agents, and employees from any and all liability, damage

or claim of any nature whatsoever arising out of, or in any way related to my participation in

this program, including but not limited to the medical authorization given to the University,

acts of God, acts or omissions of any third parties (including but not limited to common

carriers, hotels, restaurants, or other firms or agencies); and

5. I indemnify and hold the University harmless from any damage or liability incurred as a result

of any illness I may suffer, including the costs of any medical care, or any injury or damage to

the person or property of others which I may cause, or from any financial liability or obligation

which I may personally incur, while participating in the program.

D. I acknowledge that I am aware that the University has the right to make changes to the

program.

By my signature below, I certify that I understand that:

1. The University reserves the right to make changes to the program at any time and for any

reason, with or without notice, and that the University shall not be liable for any loss

whatsoever to me by reason of any such change;

2. The University reserves the right to substitute hotels or accommodations or housing of a

similar category at any time. Specific room and housing assignments are within the sole

discretion of the University; and

3. The right is reserved by the University, at its sole discretion, to cancel the program or any

aspect thereof prior to departure; and, at the University’s sole discretion, to cancel the

program or any aspect thereof after departure, requiring that all participants return to the

United States if the University determines or believes that any person is or will be in immediate and/or clear and present danger if the program or any aspect thereof is continued. Should the University cancel the program prior to its start date, a full refund of monies paid to the University by participants will be made. In the event that a program is cancelled after the start of the program, the University will refund only uncommitted and recoverable funds.

E. I acknowledge that I am responsible for my conduct during the period of my participation

in this program.

By my signature below, I certify that:

Agreement/Release Form

1.       In regard to my conduct while a participant in this study abroad program I understand that:

a. All participants in the program are subject to the University’s regulations and guidelines

(including but not limited to those contained in the General Information Handbook and

other orientation materials), my home campus’s code of conduct, the host

University’s regulations and guidelines, as well as the laws of the host country. I agree to

obey those rules, guidelines, regulations, codes, policies and laws.

b. The University reserves the right to decline to accept or retain me in the program at any

time should my actions or general behavior impede the operation of the program or the

rights or welfare of any person. Similarly, if my conduct violates any policy or procedure

of the University or the laws of the host country, I understand that I may be required to

leave the program at the sole discretion of the University’s employees, agents and

representatives, and I may be referred to the appropriate University officials for further

disciplinary or other action. In such an event, no refund will be made for any unused

portion of the program.

c. The University is not responsible for the defense of a participant accused of a violation of

the laws of the host country or rules of the host organization and is not responsible for the

payment of any fines or other penalties resulting from such violations.

2. As a participant in this study abroad program, I pledge to conduct myself in a manner that

reflects favorably on my home campus, on the University of Colorado, the University of Colorado university system, the State of Colorado, the United States of America, and myself.

3. I understand that the manufacture, distribution, possession, use or sale of controlled

substances as defined by the State of Colorado and/or U.S. Federal Law, and/or the laws of the host country is prohibited during study abroad. I understand that I will be directly subject to the laws and legal procedures of the host country as applied to the use, possession and distribution of illegal drugs, and these will be strictly enforced by local authorities.

4. I also understand that I am solely responsible for ascertaining the lawful age for the possession

or consumption of alcoholic beverages in the host country and for my conduct in compliance

with local laws as enforced by local authorities.

5. I agree to participate fully in all portions of the program and further agree that any deviation

from the design of the program’s content or format [including, but not limited to participation in

field trips, participant-initiated changes to the number or type of courses/tutorials, participantinitiated changes to existing housing arrangements, etc.] must be approved in advance in writing by Albany’s Office of International Education or the program’s resident director or

University at Albany faculty member leading the program.

6. I acknowledge that I understand that in order to secure my courses/tutorials and/or housing

placement at my overseas host institution, I may be required to submit the appropriate forms to

both the Study Abroad Office at the University of Colorado, my home campus if not

the University of Colorado at Boulder or a University within the University of Colorado system, and to the appropriate office(s) at the overseas institution in a timely manner (as

specified in the orientation materials).

7. I acknowledge that I understand that if I withdraw from the program after its start, I am obligated to repay any financial aid awards that I have received in support of my participation in the program or course. I also acknowledge that I have read the section of the General Information

Agreement/Release Form

Handbook concerning participant-initiated withdrawals from the program.

8. I acknowledge that I have received copies of the appropriate overseas academic program’s

General Information Handbook and I agree to read and to abide by the guidelines, rules and

procedures described and outlined in those orientation materials. I also agree to abide by any

rules and procedures that may be provided by faculty or staff involved in the organization,

implementation, and delivery of the program.

9. I agree to complete all the academic work required by my program or host University before the end of my study abroad term/semester/session, or academic year, whichever is applicable, and to remain on site until that date. I understand that the only exceptions to the foregoing may be earlier departure in the event of a medical or personal emergency, or in the event that I have

completed all my examinations within a stated examination period at the end of the term/semester/session or academic year, and have received permission for an early departure

from the program’s resident director or host University official and arranged for “Incomplete”

grades to be recorded, or in the case of faculty-led overseas courses, if the faculty member of

record allows course work to be completed after the overseas experience has ended.

10. I certify that I am at least 18 years of age or older.

F. I give permission for photographs of me and statements by me to be used in publicity

materials.

I give my consent for the University of Colorado, the University of Colorado system the faculty, overseas institutions, agencies, organizations and individuals cooperating with the University at Colorado’s Office of International Education in the administration of the program to use images of me or written statements from me in promotional and informational

materials.

G. I authorize the release of my student records as described below.

According to the provisions of Public Law 93-380 (20 USC 1232g-Family Educational Rights

and Privacy Act of 1974) and in connection with my participation in the University of Colorado overseas program indicated above, I hereby authorize the Study Abroad Office, the Office of the Registrar, and the Office of Financial Aid to communicate with my parents or guardian and provide to them any academic or financial information deemed appropriate by the Director of each office. I waive any requirement that I be furnished a copy of these records prior to or concurrent with their release.

This consent remains effective until my relationship with the University of Colorado overseas

program is terminated, financial accounts are settled, and grades recorded. I hereby acknowledge that I have read, understand, and will abide by each of the terms and conditions of

this Agreement and the terms of participation that are specified in the program’s orientation materials.

I agree that the terms of this Agreement/Release Form are to be construed under the laws of the University of Colorado, and that if any portion thereof is held invalid, the balance thereof shall, notwithstanding, continue in full legal force and effect. In signing this document I hereby acknowledge that I have read this entire document, that I understand its terms, that by signing it I am giving up substantial legal rights I might otherwise have, and that I have signed it knowingly and voluntarily.

PRINT FULL NAME: ______________________________________________________

SIGNATURE: ______________________________________________

DATE: ___________________

1/29/05