Assumption of Risks, Waiver of Rights, and Student Conduct Agreement For

Print, read and complete this form, including OIEC advisor’s signature. Mail with your application fee.

Assumption of Risks, Waiver of Rights, and Student Conduct Agreement for

Oregon International Education Consortium Study Abroad

I, ______, have read the webpage program description and completed the program application in order to participate in the COCC Barcelona Study Abroad Program ("Activity"), Fall quarter 2015. I understand that transportation during and participation in this Activity will expose me to risks of injuries. Some of these risks are foreseeable, but some are not. Examples include physical injury, emotional injury, property damage, economic loss, and deprivation of rights, privileges, and immunities. Some of these risks cannot be eliminated due to the nature of the Activity. I understand that these risks could cause harm to me,my property, and other persons.

I fully recognize the dangers inherent in the Activity, but I am willing to participate in it. In consideration for providing methe opportunity to participate in the Activity, I voluntarily agree to hold harmless, waive, release, indemnify, defend, and discharge Central Oregon Community College ("College") from all liability and claims arising from participation in the Activity. I agree to these actions to the fullest extent allowed by law. The"College" includes their Board of Directors and individual members thereof, officers, agents, employees, volunteers, and representatives. "Liability and claims" means demands for any value or benefit, such as lawsuits, tort claims, insurance claims, causes of action, fines, fees, and costs (e.g. medical costs and attorney fees). I further certify and represent that I have the legal authority to hold harmless, waive, release, indemnify, defend, and dischargetheCollege on behalf of myself.

In the event that I require emergency medical treatment while participating in the Activity, I authorize COCC and their agents to secure the services of a physician or hospital.

This Agreement is intended to be as broad and inclusive as is permitted by law. If any provision or any part of any provision of this Agreement is held to be invalid or legally unenforceable for any reason, the remainder of this Agreement shall not be affected thereby and shall remain valid and fully enforceable.

As ambassadors for their colleges, towns, state and country, students are held to a high standard of behavior. While participating in this Activity, I agree to behave responsibly and to respect the rights of local citizens and fellow students. Further, I understand that I am subject to the code of conduct that is part of the student rights and responsibilities at my home community college campus. Failure to adhere to the student rights and responsibilities may result in discipline, including dismissal from the Activity.

I certify that I have read this document and fully understand its contents. I attest that this document, along with the COCC Barcelona program application form, constitutethe entire agreement between OIEC/College and me, which means that all oral or written representations prior to the date of this agreement are superseded by the terms of this document and those of the application form. In exchange for the opportunity to participate in the Activity, I voluntarily agree to the terms of this document.

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Student's Signature DateStudent's Passport #

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Date of Birth EmailPhone #

Signature of Campus COCC advisor certifying Student's eligibility to apply______

Name (Print)______Title______Date______