Arab League Waiver & Release of Liability: Adult Participant

Student's First Name

Student's Last Name

Student Email

I hereby certify that I am over the age of eighteen and by my signature below, I hereby release John Carroll University (JCU), its officers, agents, employees, successors, and assigns from any and all liability, not caused directly by negligence of JCU or its representatives, arising out of or in any way related to my participation in a student field trip to participate in the National University Model Arab League at Georgetown University Hotel and Conference Center: 3800 Reservoir Road NW, Washington, D.C. 20057. The group will leave on Thursday March 26, 2020 and return on Sunday, March 29, 2020. I understand that this is a voluntary trip/activity and as with any such trip/activity there will be risks involved with these activities. I hereby accept these risks. Transportation I understand that the University is providing transportation by a vehicle rented by the University and driven by one of the students. I accept this responsibility and associated risks with this type of transportation. Overnight Accommodations I understand that the University is providing overnight accommodations and that any damages or charges as a result of my actions that are deemed to be outside of the scope of this trip will be my responsibility. I accept this responsibility and associated costs. I further understand that if I elect to stay on past the end of the program (Sunday, March 29, 2020), I will do that at my own risk and responsibility. Faculty/Staff Supervision I understand that there will be no University faculty and/or staff accompanying me on this trip and that I must comply with University policies concerning alcohol and drug use, vehicle use, student misconduct, smoking, principles of academic freedom, policy on sexual harassment, etc., just as I would on campus. I accept this responsibility. If I require medical care while participating in the activities of this trip, I authorize JCU through its employees or agents to contact the person listed below, or if that is not possible, I authorize JCU through its employees or agents to summon emergency medical care or to take me to the nearest medical facility for purposes of receiving medical care with the understanding that I will not hold JCU, or its employees, agents or representatives responsible for the actions of the agents, representatives or employees of the medical facility and that I will assume any and all responsibility for payment of same.

First Emergency Contact Name

First Emergency Contact Relationship to Student

First Emergency Contact Cell Phone

First Emergency Contact Home Phone

First Emergency Contact Work Phone

First Emergency Contact Email

Second Emergency Contact Name

Second Emergency Contact Relationship to Student

Second Emergency Contact Cell Phone

Second Emergency Contact Home Phone

Second Emergency Contact Work Phone

Second Emergency Contact Email

Physician's Name

Physician Phone

Medical Insurance Carrier

Medical Insurance Policy Number

Electronic Signature

Today's Date

National University Model Arab League NUMAL March 26-29

Arab League Waiver & Release of Liability: Adult Participant