Form for Spouse, Companion and Child L

Form for Spouse, Companion and Child
Accompanying USG European Council Study Abroad Program
This form should be completed by the spouse or friend of a program director, site director or instructor when that spouse or
friend is accompanying a study abroad program but not participating for academic credit. In addition the form should be
completed by the parent of any minor child who is accompanying the faculty/staff director or instructor.
Name of EC Faculty or Staff Member Director or Instructor
Name of Program
Program Dates: Start
Program Location(s)
Full name and relationship of individual(s) accompanying EC faculty/staff member:
1. Name
2. Name
3. Name
Relationship to Faculty/Staff Member
Relationship to Faculty/Staff Member
Relationship to Faculty/Staff Member
Please review and sign the following statement that constitutes conditions for accompanying a USG European Council study
abroad program.
1. I understand that the USG European Council (hereafter EC) faculty or staff member leading or teaching in a study
abroad program must fulfill her/his obligations to the program and its students and that these often extend throughout the
day, evening and weekends. I further understand that EC faculty/staff members leading or directing a program will not be
able to provide child care during the program and therefore another adult family member must assume full responsibility for
these duties. In addition I understand that neither EC nor any of its employees or students can assume responsibility for the
care of adults or children who accompany but are not participants in a study abroad program. Finally, I understand that the
EC has no responsibility for independent travel by any persons participating or accompanying a program.
2. I understand that, as an individual accompanying an EC study abroad program, my behavior (and/or that of my minor
child/children) reflects on the study abroad program and on the EC.
3. I understand that I (and/or my minor child/children) may have permission to accompany the study abroad program
revoked if a) I (and/or my minor child/children) engage in actions endangering myself or others, or b) my (and/or my minor
child/children) conduct is considered to be detrimental or incompatible with the best interest and welfare of the program. If
permission to accompany the study abroad program is revoked, I (and/or my minor child/children) agree to leave the study
abroad program and return to the USA at my/our own expense.
4. I understand that I (and/or my minor child/children) am subject to the laws of the host country and agree to abide by
those laws.
5. I understand that I am responsible for all expenses associated with my (and/or my minor child/children) accompanying
the study abroad program and that these expenses cannot be incorporated into the study abroad program budget, and they
cannot be part of any reimbursement request or invoice that is submitted to the EC. I further agree that any non-refundable
expenses for cancellation of arrangements made on my (and/or my minor child/childrens’) behalf will be my sole
6. I understand that the EC reserves the right to cancel programs in the case of insufficient participation or for other
reasons deemed appropriate. The EC also reserves the right to change the program including personnel, itinerary and
7. I am aware that it is both inappropriate and culturally insensitive to use this time to promote religious or political
agendas; further, such behavior can cause offense and potentially place me (and/or my minor child/children) in harm’s way.
I understand that I cannot expect to change the society I am visiting and, as a representative of the EC, I (and/or my minor
child/children) should not engage in such activities. Consequently, I will demonstrate respect for the host culture even
though I may not agree with all aspects of that culture, and I understand that behavior that is inconsistent with this statement
may lead to the revocation of my (and/or my minor child/childrens’) permission to accompany the study abroad program.
8. I understand that my (and/or my minor child/children) accompanying a study abroad program must not adversely affect
the program or program participants and must not impair the operation and administration of group activities associated with
the study abroad program, or otherwise infringe on program participants. Further, I understand that I am fully responsible
for following the itinerary of the group and for rejoining the group or returning to the program if I am separated.
I have read, understand and accept the conditions governing my accompanying an EC study abroad program.
Signature of Spouse (Also serves as parental signature for minor children)
PLEASE READ THIS DOCUMENT CAREFULLY. It affects any rights you may have if you are injured or
otherwise suffer damages while voluntarily participating in the above-named study abroad program.
In consideration for my being permitted to accompany this study abroad program, I agree to the following:
1. Assumption of Risks: I understand that there are inherent and unavoidable risks in travel abroad. I assume,
knowingly and voluntarily, the known risks and all other risks that could arise during my travel to, from, in, or
around my site country.
2. Important Websites: I acknowledge that I have been provided with the website addresses for obtaining
information on security, safety, and health for countries to which I plan to travel and that I am responsible for
informing myself of this information. The websites are:
U.S. State Department
Centers for Disease Control
World Health Organization
3. Orientation: I understand that study abroad orientation is available to me, and I understand that it is my
responsibility to attend if I so desire.
I acknowledge that participation in an international program involves some risk of injury, illness, or loss of personal
property. I agree to release and forever discharge the USG European Council and its member universities and the Board of
Regents of the University System of Georgia, its members individually, and its officers, agents, and employees, from any
and all claims, demands, rights, and causes of action of whatever kind or nature, arising from and by reason of any and all
known and unknown, foreseen and unforeseen bodily and personal injuries, including death, damages to property and the
consequences thereof, resulting from my participation in an EC study abroad program and related activities.
I certify that I am in good health and physically capable of undertaking an intensive program of foreign travel. I am
responsible for determining if there are any immunizations or other health requirements needed to accompany the program.
Furthermore, I have listed all recent or current medical or psychological history, including all ongoing prescriptions
on the participant information form. Further, I understand that I am responsible for obtaining medical, evacuation,
and repatriation insurance particularly as any insurance I currently have is not likely to apply while I am abroad.
I further agree that I shall be subject to the supervision and authority of the faculty/staff in charge and to standards of
conduct stipulated by the faculty/staff person in charge. I further acknowledge that the program and site directors have sole
authority to make decisions regarding the continued participation of individuals in the program whose conduct may
necessitate disciplinary action.
The EC also has the right to cancel the program due to low enrollments or unforeseen developments. All costs are subject
to change because of unanticipated increases in airfares or other program costs, as well as fluctuations in monetary exchange
rates. The EC will make every effort to keep program costs as advertised and will inform prospective participants of any
changes as they occur.
Unless it has been expressly agreed to and paid for, I will not receive any benefits from the study abroad program. I am
responsible for all costs associated with my and/or my children accompanying a study abroad program.
Signature of Spouse (Also serves as parental signature for minor children)
Return completed and signed form to:
European Council
Center for International Programs
Valdosta State University
1500 N. Patterson St
Valdosta, GA 31698