University of Texas at San Antonio (UTSA)

University of Texas at San Antonio (UTSA)

High Risk Trip and Project Waiver/Release

Participant’s Name:

Travel dates: ______

Travel and Project Description: (A brief description of the project. Please include the location and a brief description of where the project activities will occur).

In consideration of being allowed the opportunity to participate in the above-described Travel and Project (“the Project”), I, the undersigned, understand, acknowledge and agree to the following:

I, ______, understand that the United States Department of State has issued a “Travel Warning or Alert” for travel to , (hereinafter referred to as the “Destination Country”) a copy of which is attached to this document, and I have read and understand this Travel Warning or Alert. I understand that the University of Texas System has a Travel Policy that restricts travel to the Destination Country and charges the UTSA International Oversight Committee (“UTSA IOC”) with implementing the University’s policy pertaining to travel to the Destination Country. I understand and acknowledge (1) that the UTSA IOC has designated travel to and in the Destination Country to be High Risk Travel, and (2) that UTSA has strongly discouraged me from traveling to, in and around the Destination Country. However, notwithstanding the Travel Warnings or Alerts and the advice from UTSA, I am voluntarily choosing to travel to, in and around the Destination Country for the purposes of undertaking the Project described above.

Understanding of Risks:

1.  Field Research: I acknowledge that participating in activities relating to research conducted in the field entails numerous risks, both known and unknown. I further acknowledge the following:

·  I understand the danger involved in such activities;

·  I am the best judge of my own capabilities and limitations and I will only participate in Project activities if I feel competent and comfortable in performing them.

2.  High Risk Travel: I understand that participating in this High Risk Travel has inherent risks to me and those with me, including kidnapping and death. I also understand that these risks cannot be eliminated regardless of the care taken to avoid them. I acknowledge that I am voluntarily participating in the travel described above. I understand that the University of Texas at San Antonio is not responsible for my safety, and I knowingly and voluntarily assume full responsibility for all risks known and unknown associated with my travel. I further acknowledge the following:

·  I have carefully identified, reviewed and considered the risks of travel to the Destination Country;

·  The US Embassy may temporarily close or suspend public services for security reasons;

·  The US Embassy may not be able to provide emergency assistance to me should I require it;

·  If there is a need to evacuate in an emergency, flights may be suspended, and other departure (or shelter in place) options may be limited or non-existent;

·  Access to hospitals, emergency medical care and medications may be limited or non-existent;

·  Should I experience difficulties, UTSA, and their contracted emergency assistance provider, International SOS, may not be in a position to provide emergency assistance to me;

·  The risks and dangers of travel to, in and around the Destination Country, includes but is not limited to the dangers to my own health and personal safety, and possible death, posed by endemic and/or emerging infectious diseases, terrorism, crime, civil unrest and violence;

·  The specific risks include, but are not limited to minor and major physical injuries and/or emotional and psychological injuries inflicted accidentally or intentionally by others, or catastrophic injuries, including paralysis and death; and

·  There may be additional risks of which I am unaware or which have not been brought to my attention, and some risks are unknown and unforeseeable.

Waiver and Release of Claims.

Assumption of Risk. I hereby knowingly and willingly agree to accept any and all risks of damages, losses, illness, injury (including death) that I may sustain to my person or my property arising out of, resulting from, or relating to my participation in the Project or my participation in any travel associated with the Project.

Payment for Damage or Loss to University Property. I hereby knowingly and willingly agree to reimburse the University for any damage or loss that occurs to University property arising out of, resulting from, or relating to my participation in the Project or my participation in any travel associated with the Project.

Release. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release and hold harmless the University of Texas at San Antonio and its directors, officers, governing board, agents, employees, contractors, and subcontractors (the “Released Parties”) from any and all injuries, disabilities, death, losses, liability, claims, causes of action, damages, costs, attorneys fees, and other expenses (collectively, the “Claims”) that are associated with my participation in the Project or in any travel associated with the Project. I specifically acknowledge that this release applies regardless of the cause or causes of the claims described above and regardless of any negligence of the Released Parties.

Indemnification. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby agree to indemnify and hold harmless the Released Parties from any and all Claims of any kind or character by any person that are caused by, arise out of, or result from, in whole or in part, my participation in any activities associated with the Project or in any travel associated with the Project. I specifically acknowledge that this indemnification applies regardless of any additional cause or causes of the claims described above and regardless of any negligence of the Released Parties.

In signing this document, I acknowledge that I have had an opportunity to ask any questions I have about it, that I have read and understand it, that I accept its terms, that I have discussed it with a parent/guardian (if under that age of 18), and that I have signed it knowingly and voluntarily. I also understand that this Waiver/Release supersedes any other Waivers/Releases I may have completed regarding this Project.

Signature: ______Date: ______

If individual is under age 18 at any time during the proposed travel, his or her parent or legal guardian must sign below providing permission for the student to travel and confirming the waiver of claims set forth in the paragraph above.

I have discussed this High Risk Travel with my child/ward and I give permission for ______to travel under the terms set forth above and explicitly join in the waiver set forth above, releasing the Released Parties from any liability associated with the Project or in any travel associated with the Project.

Parent/Guardian Signature: ______Date: ______

Parent/Guardian Name/Address/Phone/E-mail:

______

______

______

______

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