XAVIER UNIVERSITY – RISK MANAGEMENT & INSURANCE AOR 106 - Student Professional Field Experience - ASSUMPTION OF RISK AND RELEASE AGREEMENT

Sep 29, 2026

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Assumption of Risk and Release Agreement for Xavier University nursing students participating in Student Professional Field Experience during the 2026-2027 academic year. The form collects student and placement details, confirms enrollment in covered classes, and describes possible off-campus experience types including clinical work, internships, practicums, and research activities. It states inherent risks to health and wellbeing, potential outcomes such as inconvenience, injury, or death, and acknowledges emergency medical care authorization and related cost responsibility limitations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Participation Acknowledgement

The Location(s)

Assumption of Risks

Rules, Procedures, and Requirements

Emergency Medical Care

Emergency Contact Information

XAVIER UNIVERSITY – RISK MANAGEMENT & INSURANCE AOR 106-Student Professional Field Experience NURSING DEPARTMENT 2026-2027 Academic Year ASSUMPTION OF RISK AND RELEASE AGREEMENT Student Professional Field Experience Rev. 03/23/2026 1 of 4 Please type or print clearly: Name: Banner ID: Entities [name of companies or organizations providing the professional field experience]: Varies Department [the department at Xavier]: Nursing Academic Year: 20 26 -20 27 Location(s) [off-campus locations of the professional field experience]: Varies Date(s) of Experience: Varies I. Participation Acknowledgement. I am participating in the professional field experience with the Entities as part of my educational experience in the Department at Xavier during the Academic Year listed above (the “Experience”) . I acknowledge that the last page of this Agreement lists the classes that include professional field experiences. I assert that Iam enrolled in one or more of the classes listed for this Department, and I understand that Experiences in those classes will be covered by this Agreement. I understand that these Experiences will be conducted at the various off-campus Locations listed above. I understand that these Experiences may include but are not limited to the following kinds and types of Experiences: assessments, classroom observations, clinical work, internships, interventions, labs, modules, practicums, research, role transitions, and service learning. II. The Location(s). I understand that unstable or unexpected conditions in the Location(s) may require changes in the planned Experience or might cause inconvenience or harm to me. I further understand that Xavier University (“Xavier”) does notown, operate, or control the Location(s) . I recognize that certain aspects of the cultural climate of the Location(s) 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(s) may be very different than exist in the Xavier Community. III. 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 personalproperty. IV. Rules, Procedures, and Requirements. By signing this Assumption of Risk and Release (the “Agreement”), I understand that through my participation in this Experience, I will represent Xavier to the people and community with whom I am working. 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 Experience I fu

FAQs

What does the student agree to regarding participation in the professional field experience?

The student confirms participation with the listed entities as part of educational experience, understands which classes are covered, and agrees that experiences will be conducted at the listed off-campus locations and may include multiple types such as clinical work and internships.

What risks does the agreement acknowledge for the student?

The agreement acknowledges inherent risks to the student’s health or wellbeing, including risks related to unfamiliarity with the experience, location, laws and customs, travel, work environment conditions, and exposures such as illness or disease, plus potential outcomes including injury or death.

How is emergency medical care handled and what are the cost responsibilities?

The student authorizes Xavier, through its representatives, to secure emergency medical care and related treatment during participation. Xavier is stated to have no duty to secure such care or assist further, and is not responsible for costs or damages arising from the participation or from assistance provided or not provided.

Sep 29, 2026

Uploaded by McGucket