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It states obligations to follow rules and procedures, authorizes emergency medical and dental treatment via university representatives, and clarifies liability and cost responsibility, including insurance coverage acknowledgement and photograph/media 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and Over)  \nASSUMPTION OF RISK AND RELEASE AGREEMENT  \nOn or Off-Campus Experience  \nNon-Xavier Individuals (18 and Over)  \nPlease type or print clearly:  \nName:    \nActivity, club, class, program, event, or trip (the “Experience”):   Location:    \nDate(s) of Experience:    \nI. Participation Acknowledgement. I am participating in the Experience, which is occurring at the Location and on the Date(s) listed above.  \nII. 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 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 if the Experience is occurring off-campus, any experiences or other activities in the Location may be very different than exist in the Xavier Community.  \nIII. 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.  \nIV. 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. 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 understand that by breaking any of these promises, or for any other reason deemed appropriate by Xavier or its representatives, that my participation in this Experience may be immediately terminated. I understand that if I am separated from this Experience for any reason, I will continue to be responsible for all Experience costs and any additional costs resulting from my early departure or dismissal.  \nV. Emergency Medical Care. I recognize that occasionally an individual participating in this type of Experience may face a health emergency requiring local hospitalization or emergency treatment. As a result, I authorize Xavier University, through its representatives, to secure emergency medical care, hospitalization, surgical treatment, or dental treatment for me during my participation in this Experience. However, I understand that Xavier University is under no duty to secure such care or assist me in any other way in the event of such a health emergency. I further understand that Xavier University is in no way responsible for any cost or other damages arising from my participation in this Experience, or resulting from any assistance provided or not provided under this paragraph.  \nThis is the only form approved by Xavier University for this purpose. It may not be modified or changed in any way.  \nXAVIER UNIVERSITY – RISK MANAGEMENT & INSURANCE Rev. 6/23/2020  \nAOR 107-Non-Xavier Individuals (18 and Over)  \nVI. Eme","cbCaimzBWhdzd3qn","https://ap.wps.com/l/cbCaimzBWhdzd3qn","pdf",82564,"English","# Assumption of Risk and Release Agreement\n## Participation Acknowledgement\n## Location and Cultural Conditions\n## Assumption of Risks\n## Rules, Procedures, and Requirements\n## Emergency Medical Care\n## Emergency Contact Information\n## Health History\n## Medical Insurance Coverage\n## Photograph/Media Consent and Release","[{\"question\":\"Who is this agreement for?\",\"answer\":\"Non-Xavier individuals aged 18 and over participating in an on-campus or off-campus experience.\"},{\"question\":\"What risks does the agreement acknowledge?\",\"answer\":\"It acknowledges inherent and unforeseeable risks to health or wellbeing, including travel-related risks, exposure to sickness or disease (including COVID-19), allergic reactions, contaminated food or water, and possible injuries or death.\"},{\"question\":\"What medical and insurance responsibilities are assigned?\",\"answer\":\"The participant authorizes the university to secure emergency medical care but the university has no duty to provide care or assistance, and the participant acknowledges responsibility for related costs, including acknowledgment of whether required medical insurance coverage exists.\"}]","XAVIER UNIVERSITY - RISK MANAGEMENT & INSURANCE - ASSUMPTION OF RISK AND RELEASE AGREEMENT | PDF",1790653767]