Participation in High Risk Activities
The University of Wisconsin Oshkosh is committed to maintaining an academic and social
environment which promotes the intellectual and personal development of students and the
safety and welfare of all group members.
I _________________________ (name) understand that the type of activity I am proposing to
engage in is not sponsored by the University, that the university cannot guarantee my health or
safety, and that participation in high-risk activities is discouraged by the University.
I further affirm that ________________ (program leader name) has advised that I not participate
in activities such as _____________________________________________________________
_____________________________________________________________________________,
that my health insurance policy may not cover injuries related to my participation in such
activities and that any decisions I make contrary to the advice I have been given I have made
taking this advice into consideration. I further affirm that I have discussed my plans with my
parents and/or spouse and/or other family members, and that I am following their advice.
I understand that I am on a University-sponsored program for the purpose of earning academic
credit on an academic program. If I choose to participate in activities for other purposes, and if I
am injured while participating in these activities, the University will contact my parents or
spouse and they will become responsible for my health and welfare. Specifically, they will be
responsible for arrangements and cost of traveling to my current location to manage any
hospitalization, medical evacuation to the U.S. and/or repatriation of my remains to the U.S.
I agree, on behalf of my family, heirs, and personal representative(s), to assume all the risks and
legal and financial responsibilities surrounding my participation in activities I organize on my
own. To the maximum extent permitted by law, I release and indemnify the Board of Regents of
the University of Wisconsin System, 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. I have carefully read this Release Form before
signing below. No representations, statements, or inducements, oral or written, apart from the
foregoing written statement, have been made. This agreement shall be governed by the laws of
the state of Wisconsin, which shall be the forum for any lawsuits filed under or incident to this
agreement or to the Program.
Program Participant Signature
Date
OFFICE OF INTERNATIONAL EDUCATION
UNIVERSITY OF WISCONSIN OSHKOSH * 800 ALGOMA BLVD * OSHKOSH, WI 54901
(920)424-0775 * FAX (920)424-0247 * EMAIL OIE@UWOSH.EDU
www.uwosh.edu/oie