THIS IS A RELEASE OF LEGAL RIGHTS-READ AND UNDERSTAND BEFORE SIGNING

The following agreement is designed to protect students, faculty, Winthrop University, and the other universities, programs, agents and agencies cooperating with Winthrop University’s Study Abroad Salamanca Program. We ask that all students (and parents as necessary) sign this form to indicate their agreement and consent to the terms contained herein.

Winthrop University does not discriminate against individuals who have or have had physical, emotional or mental disorders. Such information may be important, however, in trying to place students in appropriate study abroad programs, particularly when their medical condition(s) may pose a risk to the health and safety of themselves and others. In addition to the requirements of this form, students are invited to provide the Office with any health information they fell may be helpful in either selecting or participating successfully in a study abroad program.

I hereby agree as follows:

1. Risks of Study Abroad. I understand that participation in the study abroad programs involves risks not found in study at Winthrop University. These include risks involved in traveling to and within, and returning from, one or more foreign counties; foreign political, legal, social, and economic conditions; different standards of design, safety and maintenance of buildings, public places and conveyances; local medical and weather conditions; and other matters. I have made my own investigation and am willing to accept these risks.

2. Institutional Arrangement. I understand that Winthrop University does not represent or act as an agent for, and cannot control the acts or omissions of, any host institution, host family, transportation carrier, hotel, tour organizer or other provider of goods or services involved in study abroad programs. I understand that the University is not responsible for matters that are beyond its control. I hereby release the University from responsibility for any injury, loss, damage, accident, delay or expense arising out of any such matters.

3. Independent Activity. I understand that the University is not responsible for any injury or loss I may suffer when I am traveling independently or otherwise separated or absent from any University-supervised activities.

4. Health and Safety.

A. I have consulted with a medical doctor with the regard to my personal medical needs. There are no health-related circumstances, which preclude or restrict my participation in the study abroad programs.

B. If I have experienced any medical or psychological problems, which may pose a direct threat to the health or safety of myself and/or others while I am abroad, I will provide the details of any such problems in the lines provided below or on attached pages. For those individuals who are disabled, the use of such information will be limited to those purposes permitted by the Americans with Disabilities Act. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C. I am aware of all applicable personal medical needs. I have arranged, through insurance or otherwise, to meet any and all needs for payment of medical costs while I participate in any study abroad or similar program. I recognize that Winthrop University is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. If I require medical treatment or hospital care, in a foreign country or in the United States, during my participation in any study abroad program, the University is not responsible for the cost or quality of such treatment or care. If I have supplied health information in Section 4(B) or elsewhere in this document, I agree that Winthrop University’s knowledge of such information does not render the University responsible for any related harm caused to myself from result from any health condition(s) described herein.

D. 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 such actions.

5. Assumption of Risk and Release of Claim. Knowing the risks described above, and in consideration of being permitted to participate in a study abroad program, I agree, on behalf of my family, heirs, and personal representative(s), to assume all the risks and responsibilities surrounding my participation in such programs. To the maximum extent permitted by law, I release and indemnify Winthrop University and its officers, employees and agents, from and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, during my participation in a foreign study program (including periods in transit to or from any country where such a program is being conducted).

6. Right of Notification. Not withstanding any law to the contrary, I understand that under certain circumstances Winthrop University personnel reserve the right to notify my family, host family, and other Winthrop University and/or host institution personnel—as well as law enforcement and medical authorities.

7. Right of Termination. I understand the Winthrop University reserves the right to terminate my participation at any time during the period of study abroad if I fail to meet the requirements of academic standards and general behavior as written in the university handbook or delineated by the program director. If my participation is terminated, I consent to being sent home at my own (or my parents’) expense with no refund of program tuition and other costs.

8. Role of Program Leaders, Faculty and Staff. I understand that the program leaders, directors, and faculty are acting solely in their capacity as agents of Winthrop University, and I agree to waive any and all claims against them individually or the University for losses occasioned to me by any delays in arrivals or departures of air flights or for the failure, due to bankruptcy or otherwise, of the companies providing transportation, hotel, food, tour services, or other goods or services.

I have carefully read all two pages of this form before signing it. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. This agreement shall become effective only upon its receipt by Winthrop University and shall be governed by the laws of the state of South Carolina, which shall me the only forum for any lawsuits filed under or incident to this agreement, or arising out of events sponsored by or associated with Winthrop University’s Study Abroad Salamanca Program.

Name: _______________________________________________________________________________

Street Address: _______________________________________________________________________

City, State, Zip: ______________________________________________________________________

Telephone Number: ( ) _____-________

Email Address: ________________________________________

Social Security Number: _______-________-__________

X________________________________________ _______________________________

Signature Date

(If Student is under 18 years of age, a parent or legal guardian must also sign this form.)

I am the parent or legal guardian of the above Applicant, have read the foregoing Form (including such parts as may subject me to personal financial responsibility), and am and will be legally responsible for the obligations and acts of the student as described in this Form, and agree, for myself and for the student, to be bound by its terms.

X_______________________________________ _________________________________

Signature of Parent/Guardian Date