XAVIER UNIVERSITY - RISK MANAGEMENT & INSURANCE - AOR 102 - Overnight Experience - Domestic and International (Xavier Student, Employee, or Faculty Member) - Assumption of Risk and Release Agreement

Sep 29, 2026

Uploaded by Theodore

Assumption of Risk and Release Agreement for Xavier University participants in an overnight experience occurring off-campus, covering domestic and international activities for Xavier students, employees, or faculty. The agreement requires clear participant information, acknowledges location uncertainty and lack of Xavier control, addresses traveling alone responsibility, and lists broad inherent risks to health and wellbeing, including COVID-19 and related exposures. It also commits participants to follow all Xavier and handbook policies, authorizes emergency medical care, disclaims related duties or costs, and collects emergency contact and health information details.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Participation Acknowledgement

The Location

Traveling Alone

Assumption of Risks

Rules, Procedures, and Requirements

Emergency Medical Care

Emergency Contact Information

Health History

XAVIER UNIVERSITY – RISK MANAGEMENT & INSURANCE Rev. 6/23/2020 AOR 102-Overnight Experience – Domestic and International (Xavier Student, Employee, or Faculty Member) ASSUMPTION OF RISK AND RELEASE AGREEMENT Overnight Experience – Domestic and International Please type or print clearly: Name: Banner ID: Role: Xavier Student, Xavier employee, or Xavier faculty member Activity, program, event, or trip (the “Experience”): Location [where the Experience will take place]: Date(s) of Experience: I. Participation Acknowledgement. I am participating in the Experience that is occurring off-campus at or in the Location listed above. II. The Location. I understand that unstable or unexpected conditions in the Location may require changes in the planned Experience or might cause inconvenience or harm to me. I further understand that Xavier University (“Xavier”) does not own, operate, or control the Location. I recognize that certain aspects of the cultural climate of the Location may be materially different from that of my own culture or that of the Xavier Community. I further recognize that any experiences or other activities in the Location may be very different than exist in the Xavier Community. III. Traveling Alone. If applicable, I acknowledge that I am traveling without any Xavier representative and without other Xavier students, and as such, I take full responsibility for myself and anything that may occur while participating in this Experience. [initial to acknowledge this section only if you will be traveling alone] Assumption of Risks. I realize that there may be inherent risks to my health or wellbeing as a result of my participation in this Experience, which Xavier cannot anticipate, change or improve. Such risks include but are not limited to any risk inherent in this type of Experience, inexperience, or unfamiliarity with this type of Experience or its requirements, unfamiliarity with the Location(s), travel to, from and around the Location(s), unfamiliarity with laws, culture or customs, unfamiliarity with work environment conditions or requirements, riot, violence, terrorism, exposure to sickness or disease including the novel coronavirus COVID-19, allergic reaction, contaminated food or water, unfamiliar climate, complications from weather conditions, inadequate or unavailable healthcare facilities or assistance, inadequate, faulty, inappropriate or lack of training or instruction, inadequate, faulty, inappropriate or lack of equipment, accident, or mistake. I recognize that these risks may result in inconvenience, loss, injury, or damage to me, including personal injury, up to and including my death, or damage or loss of my personal property. IV. Rules, Procedures, and Requirements. By signing this Assumption of Risk and Release (the “Agreement”), I promise to abide by all rules, procedures, and requirements while participating in this Experience, including rules and procedures set forth in the Student Handbook or Faculty Handbook, available online at [www.xavier.edu/policy](www.xavier.edu/policy), and all other Xavier policies and procedures, including the Harassment Code. I understand that the Student Handbook, Faculty Handbook, and all other Xavier procedures continue to apply even if I am participating in an off-campus activity. If I am a Xavier faculty member or Xavier employee, I understand that the Harassment Code and Accountability Procedures, as well as all other campus policies, continue to apply during this Experience even if I am not acting in my capacity as a Xavier faculty member or employee. I further promise to exercise common sense and good judgment, and to conduct myself at all times in a manner that is appropriate to this Experience. I promise to abide by the participating Xavier faculty member or employee’s discretion regarding any particular interpretation of any of these terms and promises, and I promise to follow the participating Xavier faculty member or em

FAQs

What does the participant acknowledge in the Participation Acknowledgement section?

The participant acknowledges they are participating in the off-campus overnight experience at the listed location and understands the agreement applies to that experience.

How does the agreement describe Xavier’s responsibility for the location and potential changes?

The agreement states Xavier does not own, operate, or control the location and that unstable or unexpected conditions may require changes that could inconvenience or harm the participant.

What emergency medical authority does Xavier have under this agreement?

The participant authorizes Xavier, through its representatives, to secure emergency medical care, hospitalization, surgical treatment, or dental treatment if a health emergency occurs, while also acknowledging Xavier has no duty to provide care or assistance beyond securing such treatment.

Sep 29, 2026

Uploaded by Theodore