C AL POLY TR AVEL ABROAD
A SSUMP TION OF RISK AND RELEA SE AGREEMENT
0 AY 2015-2016
0 AY 2016-2017
0 AY 2017-2018
International Center
Today’s Date:
Destination: Dates of the travel: To be completed by each student participant
Read, complete, and sign the following document:
This is a release of legal rights – Read and understand before signing
Name of Participant: I HEREBY AGREE A S FOLLOWS:
RISKS OF OFF CAMPUS STUDY
I understand that participation in this Travel involves risk not found in study at the University. These may
include risks involved in traveling to and within, and returning from, one or more foreign countries; foreign
political, legal, social and economic conditions; different standards of design, safety and maintenance of
buildings, public places and conveyances; local sanitation, medical and weather conditions. Applicable
current travel advisories issued by the U.S. Department of State and the Center for Disease Control have
been received and reviewed in the travel orientation materials, and are incorporated by reference into this
Assumption of Risk and Release Agreement.
RISKS OF AIR TRAVEL
Participation in this travel requires air travel. Air travel involves risks to personal safety which could result in
damage to property, injury or death. The California State University assumes no liability for damage, injury,
and death, which may occur during air travel required by participation in this travel. Your participation in this
travel is voluntary and you participate at your own risk.
I have made my own investigation regarding risks of participation and am willing to accept these risks.
Initial: Date: HEALTH AND SAFETY
I have consulted with a medical doctor with regards to my personal medical needs. I am aware of all
applicable personal medical needs. There are no health-related reasons or problems that preclude or restrict
my participation in the Travel.
I understand that medical care and coverage vary from country to country. I recognize that health care facilities
and services may not meet the standards of those in the United States and they may not be available at all.
I agree to meet any and all of my needs for payment of medical costs while I participate in the Travel. I
recognize that the University is not obligated to provide any of my medical or medication needs. If I require
medical treatment or hospital care, in a foreign country or in the United States during the Travel, the
University is not responsible for the cost or quality of such treatment or care.
The University may, but is not obligated to, take any actions it considers to be warranted under the
circumstances regarding my health and safety. I agree to pay all expenses relating thereto and release the
University from any liability for any actions.
I assume all risk and responsibility for my medical needs.
Initial: Date: STANDARDS OF CONDUCT
I understand that each foreign country has its own laws and standard of acceptable conduct, including
dress, manners, morals, politics, drug use and behavior. I recognize that behavior which violates those laws
or standards could harm the University’s relations with those countries and institutions therein, as well as my
own health and safety. I will become informed of, and will abide by, all such laws and standards for each
country to or through which I will travel during the Travel.
I also will comply with the University’s rules, standards, and instructions for student behavior. I waive and
release all claims against the University that arise at a time when I am not under the direct supervision of the
University or that are caused by my failure to remain under such supervision or to comply with such rules,
standards, and instructions.
I acknowledge and understand that any violation of the above standards of conduct, could lead to sanctions
being imposed on me that are consistent with CSU Student Discipline Policies and Procedures, including, but
not limited to suspension or expulsion for the travel.
I will attend to any legal problems I encounter with any foreign nationals or government. The University is not
responsible for providing any assistance under such circumstances.
Initial: Date: INDEPENDENT ACTIVITY AND TRAVEL
I understand that the University is not responsible for any injury or loss I may suffer when I am acting or
traveling independently or am otherwise separated or absent from any University-supervised activities. This
includes but is not/limited to “free time’ during the travel.
I accept all responsibility for loss or additional expenses due to delays or other changes in the means of
transportation, or other services, or sickness, weather, strikes, or other unforeseen causes.
If I become detached from the Travel group, fail to meet a departure by airplane, or train, or become sick or
injured, I will, at my own expense, seek out, contact, and reach the Travel group at its next available destination.
I waive and release all claims against the University that arise at a time when I am not under the direct
supervision of the University or that are caused by my failure to remain under such supervision or to comply
with such rules, standards and instructions.
Initial: Date: INSTITUTIONAL ARRANGEMENTS
I understand that the University does not represent or act as an agent for, and cannot control the acts or
omissions of, host institution, host family, transportation carrier, hotel, tour organizer or other provider of
goods or services involved in the Travel. I understand that the University is not responsible for matters that
are beyond its control. I hereby release the University from any injury, loss, damage, accident, delay or
expense arising out of any such matters.
TRAVEL CHANGES
The University has the right to make cancellations, substitutions or changes in case of emergency or changed
conditions or in the interest of the Travel. I understand that the University’s fees and travel charges are based
on current airfares, lodging rates, and travel costs which are subject to change. If I leave or am expelled from
the Travel for any reason, there will be no refund of fees already paid.
Initial: Date: International Center
ASSUMPTION OF RISK AND RELEASE OF CLAIMS
In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs
and representatives, I release from all liability and promise not to sue the State of California, the Trustees
of The California State University, California Polytechnic State University, the Cal Poly Corporation, and their
employees, officers, directors, volunteers and agents (collectively “University”) from any and all claims,
including claims of the University’s negligence, resulting in any physical or psychological injury (including
paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my participation
in this Activity, including travel to, from and during the Activity.
I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and
participating in this Activity, which include but are not limited to physical or psychological injury, pain,
suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or
emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s
actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s).
Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this
Activity, including travel to, from and during the Activity.
I agree to hold the University harmless from any and all claims, including attorney’s fees or damage to my
personal property that may occur as a result of my participation in this Activity, including travel to, from
and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the
University. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result
of such treatment. I am aware and understand that I should carry my own health insurance.
I am 18 years or older. I understand the legal consequences of signing this document, including (a)
releasing the University from all liability, (b) promising not to sue the University, (c) and assuming all
risks of participating in this Activity, including travel to, from and during the Activity.
I understand that this document is written to be as broad and inclusive as legally permitted by the State
of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by
the remaining terms.
I have read this document, and I am signing it freely. No other representations concerning the legal effect
of this document have been made by me.
Signature of Participant:
Date: RETURN SIGNED FORM TO SPONSORING STAFF, FACULTY, OR DEPARTMENT
International Center