CLAREMONTGRADUATEUNIVERSITY
MASTEROFPUBLICHEALTHINTERNSHIPPROGRAM
RELEASEFORINTERNATIONALTRAVEL
InconsiderationofmyparticipationinaPublicHealthInternshipatClaremontGraduateUniversity("CGU"),Iagree
asfollows:
ItismyunderstandingthatCGUisnotmakingtravelarrangementsaspartofthecourseentitledCGH
306:SupervisedFieldTraininginPublicHealth.I,therefore,understandthatIacceptfullresponsibilityfortravel
arrangementsandtheassociatedcosts,andthatCGUisnotresponsibleforarrangingorpayinganyportion
thereof.
IunderstandthatparticipationintheInternshipmaybedangerous.Ifurtherunderstandthatforeign
travelmaybedangerous.AlthoughCGUmayofferinformationtomeonaspectsofforeigntravelandparticular
destinations,IagreethatIamresponsiblefordeterminingthepotentialdangersofparticulardestinations,andI
acknowledgethatCGUisundernodutytowarnmeofanyparticulardangerorpotentialinjury.Iamparticipating
intheInternshipwithfullknowledgeoftherisksinherentinsuchparticipation,includingpossiblephysicalinjury,
illness,orotherlossordamageastheresultofworkingforextendedperiodsinapublichealthsite,traveltosites
toperformpublichealthservices,andworkinginsitesthatmaybedangerousand/orunstableastheresultof
naturaldisaster,politicalunrest,orothervolatilecircumstance.Iagreetoacceptandassumeanyandallrisks
associatedwithparticipationintheInternship.InconsiderationofCGU'sacceptingmeintotheInternship,I,my
heirs,executors,administrators,employers,agents,representatives,insurersandattorneys,herebyreleaseand
dischargeCGU,itsofficers,trustees,facility,employees,agentsandrepresentatives(hereafter"releasedparties")
fromanyandallclaimswhichmayarisefromanycausewhatsoever,regardlessofthesource,exceptforgross
negligenceorwillfulmisconductonthepartofthereleasedparties,oranyofthem.Ifurtherreleaseand
dischargethereleasedpartiesfromresponsibilityforanyaccident,illness,negligence,orinjury,oranyother
consequencesarisingorresultingdirectlyorindirectlyfrommyparticipationintheInternship,unlesscausedby
thegrossnegligenceorwillfulmisconductofthereleasedparties,oranyofthem.
IalsoacknowledgethatCGUassumesnoresponsibilityinwholeorinpart,foranydelays,delayedor
changeddepartureorarrivaltimes,farechanges,dishonorsofhotel,airlineorvehiclerentalreservations,missed
carrierconnections,sickness,disease,injuries(includingdeath),losses,damages,weather,strikes,actsofGod,
circumstancesbeyondthecontrolofCGU,war,quarantine,civilunrest,publichealthrisks,criminalactivity,
terrorism,expense,accident,injuriesordamagetoproperty,bankruptciesofairlinesorotherserviceproviders,
inconveniences,cessationofoperations,mechanicaldefects,failureornegligenceofanynaturehowsoevercaused
inconnectionwithanyaccommodations,restaurant,transportation,orotherserviceorforanysubstitutionof
hotelsorofcommoncarrierbeyondCGU'scontrol,withorwithoutnotice,foranyadditionalexpensesoccasioned
byanyoftheforegoing.Ifduetoweather,flightschedulesorotheruncontrollablefactorsIamrequiredtospend
additionalnights,CGUwillnotberesponsibleformyhotel,transfers,mealcostsorotherexpenses.Mybaggage
andotherpersonalpropertyarecompletelymyresponsibilityandlossofordamagetosuchpropertyisatmyown
risk.
IrepresentandagreethatIamandwillbecoveredthroughouttheInternshipbyapolicyof
comprehensivehealthandaccidentinsurancewhichprovidescoverageforinjuriesandillnessesthatIsustainor
experienceoutsideoftheUnitedStates,and,morespecifically,inthecountriesinwhichIwillbelivingand/or
travelingwhileintheInternship.Bymysignaturebelow,Icertifythatmyhealthinsurancepolicywilladequately
covermewhileoutsidetheUnitedStates;andIabsolveCGUofallresponsibilityandliabilityforanycharges,bills
and/orexpensesImayincurwhileIamabroad.IagreetoreporttoCGU'sInternshipDirectoranyphysicalor
mentalconditionthatIhavewhichmayrequirespecialmedicalattentionoraccommodationduringtheInternship
atleastninety(90)dayspriortodeparture.
Iherebyagreetoindemnifyandholdharmlessthereleasedpartiesfromanylossorliabilitywhatsoever
includingreasonableattorneys'fees,causedbyanyactoromissionofmineinthecourseofmyparticipationinthe
Internship.
IunderstandandagreethatIwillobeyallrules,regulations,andlawsoftherespectivecountriestobe
visited,andalltravelregulations,anyrulesorprecautionsissuedbyCGU,itsrepresentativesorbyanyassociated
institutionsororganizationsortheUnitedStatesgovernment.Ialsounderstandthatinthesolediscretionofthe
Internshiprepresentative,aviolationoftheabovemayresultinanimmediateexpulsionfromtheInternship.CGU
reservestherighttodeclinetoacceptorretainmeintheInternshipatanytimeshouldmyactionsorgeneral
behavior,solelyasdeterminedbyCGU,impedetheoperationoftheInternshiportherightsorwelfareofany
person.Insuchevent,norefundwillbemadeforanyremainingportionoftheInternship.
IunderstandthatCGUreservestherightinitssolediscretiontocancelorsuspendtheInternshipforany
eventsorcircumstancesthatmay,inCGU'ssoledetermination,placemeatriskofmental,emotionalorphysical
harmorbodilyinjury,includingbutnotlimitedtowar,politicalupheaval,riotsorothereventsinoraroundthe
locationoftheInternship.CGUmayrelyontraveladvisoriesissuedbytheU.S.StateDepartmentindetermining
whethertocancelorsuspendtheInternship.CGUmaycancelorsuspendtheInternshiporsubstituteclassesdue
tolowenrollmentsorunavailabilityoffacultyorfacilities.
Bysigningbelow,IrepresentthatIamastudentingoodstandingatCGUandhaveneverhadcharges
broughtagainstmebeforetheCGUOfficeofStudentConduct.IherebygivetheOfficeofStudentAffairstheright
toaccessmyrecordsmaintainedbytheCGUOfficeofStudentConduct,andtoproviderelevantinformationfrom
suchrecordstotheInternshipDirector.
IunderstandandagreethatifanyprovisionofthisReleaseortheapplicationthereofisheldinvalid,the
invalidityshallnotaffectotherprovisionsorapplicationsofthisReleasewhichshallremainfullyenforceable.
ThisReleaseshallbeconstruedinaccordancewith,andgovernedby,thelawsoftheStateofCalifornia.
SubjecttoapprovalfromCGU'sinsurancecarrier,anydisputearisingfromthisReleaseshallbesubmittedforfull
andfinalresolutiontoarbitrationinaccordancewiththerulespromulgatedbytheAmericanArbitration
Association.ThearbitrationshalltakeplaceinLosAngelesCounty,California.
ThisRelease,theMasterofPublicHealthInternshipStudentAgreement-LegalForm,and,ifapplicable,
theMasterofPublicHealthInternshipStudentTransportationWaiver(DomesticTravel),arethesoleand
completeagreementsofthepartiesrelatinginanywaytothesubjectmatteroftheseagreements.These
agreementsshallberead,interpretedandenforcedinconjunctionwitheachother.Nostatements,promisesor
representationshavebeenmadebyanypartytoanyother,orreliedupon,andnoconsiderationhasbeenoffered
orpromisedotherthanasexpresslystatedintheseagreements.
IacknowledgethatIhavereadthisReleaseandthatIunderstanditsmeaningandeffect.
Date:
Student: