Statement of Responsibility and Release of Claims Form

STATEMENT OF RESPONSIBILITY AND RELEASE OF CLAIMS
REGARDING INTERNATIONAL PROGRAMS
I am duly enrolled in the Education Abroad Program offered by The University of Akron's
_______________________________________________________________________________________
(department or college)
through the _____________________________________________________________________________
(name of program)
in_____________________________________________________________________________________
(country or countries)
during _______________________________________, __________________________.
(term)
Special Conditions: I understand that this Program will require my traveling outside of the United States and that I may
face special conditions abroad. To the extent that I have had any questions or concerns regarding conditions or risks of
the Program, I have had the opportunity to discuss these issues with the group leader(s).
Behavioral Responsibilities: I am aware of the expected behavioral responsibility while participating in this program.
As a guest in a foreign country, there are certain behaviors which will be unacceptable and could lead to possible
disruption of my program. I assure the University that I shall conduct myself in an appropriate manner at all times. Such
behavior shall include moments when in the company of other program members and moments when I may be
physically separated from other program members or the group leader(s). I understand that I will be personally
responsible for my day-to-day activities and for ensuring my health and safety during my trip abroad.
I understand that if I violate rules and guidelines for the Program, or other applicable University rules while participating
in the Program, that I may be subject to discipline in accordance with those rules. I further understand that The
University of Akron reserves the right to terminate my participation in the Program, if I violate these rules, and to return
me to the United States without a refund of fees paid; and, The University of Akron will not pay any fee incurred in my
return to the United States.
Academic Responsibility: I acknowledge and understand that I am responsible for maintaining a course of study while
abroad. I guarantee that I will attend all classes, take all examinations and do all assigned work.
Legal Problems: I acknowledge and understand that should I fall into legal problems with any foreign nationals or
government jurisdictions, that I will attend to the matter personally with my own personal funds. The laws of many
foreign countries do not provide for due process and individual rights to the same extent as the laws of the United States.
The University cannot officially represent me or my legal interests, nor can the University assume any direct
responsibility for the actions of a foreign government.
(over)
(year)
Office of the Vice President for Student Affairs
Office of International Programs
The Polsky Building 483
Akron, OH 44325-3101 USA
(330) 972-6349 ● (330) 972-8604 Fax
The University of Akron is an Equal Education and Employment Institution

Travel: I understand that I will be responsible for obtaining my own passport, health certificate and other necessary
travel documents. I acknowledge and understand that in the event that I become detached from the group, fail to meet a
departure bus or train, or become sick or injured, I will bear all responsibility to seek out, contact, and reach the group at
its next available destination; and, I understand that I shall bear all costs attendant to contacting and reaching the program
site.
The University of Akron cannot assure that travel arrangements will be without certain disruption. Transportation may
not be as reliable or subject to the same safety standards applicable to public carriers in the United States. Accordingly, I
acknowledge and agree to accept all responsibility for loss or additional expenses due to delays or other changes in the
means of transportation, other services, sickness, weather, strikes, or other unforeseen causes.
I acknowledge and understand that The University of Akron assumes no liability whatsoever for any loss, damage,
destruction, theft or the like to my luggage or personal belongings. I also acknowledge that I have retained adequate
insurance or have sufficient funds to replace such belongings and will hold the University harmless therefrom.
Medical Responsibility: I am aware that there are certain risks inherent in international travel and that The University of
Akron, as a State of Ohio educational institution, cannot assume responsibility for all or certain of my activities. Health
care, medicines and related services may not be as readily available or of a quality comparable to those in the United
States. I am aware of my personal medical needs and hereby assure the University that I have consulted with a medical
doctor, as I have deemed necessary with regard to any personal needs. Further, I am aware that the University cannot be
responsible for attending to any of my medical needs.
I am aware that, should I be required to be hospitalized while in a foreign country or in the United States during this
Program, the University cannot and does not assume any legal responsibility for payment of such costs; rather, I hereby
assure the University that I have assumed all risk and responsibility therefor and that I have adequate insurance coverage
to meet any and all needs for payment of hospital or other medical costs during this program.
To the extent that I require special accommodation as part of the Program, I have discussed those needs with the group
leader prior to committing to the Program.
Change in the Program: I acknowledge and understand that no refunds for program fees will be made after departure.
Certain unrecoverable costs may also be assessed to me if cancellation is necessary before departure. I acknowledge the
right of the University to withdraw, change, alter, delete or modify the itinerary and/or academic program as deemed
necessary by the University.
Authorization: I authorize the use of my name, likeness and program evaluations for promotional purposes for the
Education Abroad Program at The University of Akron.
In consideration for the opportunity to participate in the Program, I hereby release and forever discharge The University
of Akron, its Board of Trustees, officers, employees and agents from any and all claims for injury, damage, or loss of any
kind, which may arise out of my participation, other than those claims directly attributable to the negligent acts or
omissions of The University of Akron.
This agreement shall be construed under and in accordance with the laws of the State of Ohio.
I certify that I have fully read this release and that I understand its terms and conditions and agree to be bound by them. I
also certify that I am over the age of eighteen (18) and have executed this agreement of my own free will.
Witness:
___________________________________________
Print Name
___________________________________________
Signature of Witness
Revised 3-1-11
Participant:
____________________________________________
Print Name
____________________________________________
Signature of Participant
____________________________________________
Date