Waiver for Study Abroad in Japan
University of Wisconsin-Madison
I understand and acknowledge that my participation in a study abroad program in Japan is voluntary. Without reservation or limitation, I assume all risks associated with my participation in said program.
I understand that there are always many unpredictable and serious risks associated with travel and study abroad, and that there are additional risks related to health and safety in Japan related to the damaged Fukushima Daiichi Nuclear Power Plant, as a result of the earthquake and tsunami that occurred on March 11, 2011.
I understand that it is my responsibility to remain informed about the health and safety risks that relate to studying in Japan. UW-Madison encourages all students, regardless of their destination, to schedule a medical consultation with a health care provider to discuss personal health concerns. For students studying abroad in Japan, it is strongly recommended that you consider a medical consultation to discuss specific medical concerns related to your health and safety in Japan.
I understand that, in the event of a mandated evacuation from Japan, due to any event(s) or condition(s) related to (1) aftershocks from the March 11, 2011 earthquake or (2) the Fukushima Daiichi Nuclear Power Plant, I will be financially responsible for all costs related to evacuation from Japan. I acknowledge that all study abroad participants on an International Academic Programs study abroad program are enrolled in the Cultural Insurance Services Abroad (CISI) international health insurance plan, but that this plan will not financially cover evacuation from Japan for any event(s) or condition(s) related to(1) aftershocks from the March 11, 2011 earthquake or (2) the Fukushima Daiichi Nuclear Power Plant.
Given the range of risks generally associated with travel and study abroad, and the likelihood that some or all of these risks are pertinent to an academic program located in Japan, I hereby acknowledge that I assume all responsibility for my personal health, safety and welfare as a consequence of my voluntary participation in the program named below. I further acknowledge that no person at the UW-Madison has or can offer me any guarantees regarding my personal health, safety and welfare, and that I have not been provided with any assurances about local conditions in the country to which I will travel that I construe as such guarantees.
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Signature Date
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Print Name
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Print name of program abroad for which you have been accepted and wish to participate