ACCEPTANCE FORMS FOR BABSON COLLEGE INTERNATIONAL PROGRAMS

Transcription

1 ACCEPTANCE FORMS FOR BABSON COLLEGE INTERNATIONAL PROGRAMS All forms in this packet should be returned to Global Program Services, Nichols Hall, by the date indicated by your program manager. Failure to do so may result in your removal from the program. WORKING KNOWLEDGE RESEARCH PROGRAM FORM 1: FORM 2: FORM 3: and 3A FORM 4: FORM 5: FORM 6: WAIVER OF LIABILITY, COVENANT, RELEASE AND HOLD HARMLESS AGREEMENT This form must be signed by the student in the presence of a notary public. Please bring proper identification, such as a driver s license or a passport. Your Babson ID card in not sufficient. If you are under 21, your parent/guardian must also sign this form, although it does not have to be in the presence of the notary public. ACKNOWLEDGEMENT OF BABSON COLLEGE S OVERSEAS PROGRAM CANCELLATION POLICY If you are under 21, your parent/guardian must also sign this form. EMERGENCY MEDICAL AUTHORIZATION AND PARENTAL CONSENT This form must be filled out and signed by you. If you are under 21 at the time the program departs, this form must also be signed by a parent or legal guardian. This is for your protection. Should an emergency arise while you are overseas, the faculty or staff adviser at Babson or international resident director will be authorized to obtain necessary medical care for you. If you choose not to authorize the faculty or staff adviser or resident director to obtain emergency care for you, the form still needs to be signed and returned (sign under, I choose not to authorize the faculty adviser or the international resident director ). INSURANCE INFORMATION/WAIVER OF MEDICAL INSURANCE Make sure to check the appropriate box as to which insurance coverage you have and complete the form if you do not have Babson College s medical insurance. PASSPORT INFORMATION FORM RELEASE FORM THESE DOCUMENTS HAVE IMPORTANT LEGAL CONSEQUENCES. DO NOT SIGN THEM UNLESS YOU UNDERSTAND WHAT THEY MEAN. Babson Park, MA ww w.babson.edu/gps

2 RELEASE FORM WAIVER OF LIABILITY, COVENANT, RELEASE AND HOLD HARMLESS AGREEMENT Form 6 Form 1 INFORMATION RELEASE: Please check and initial all that apply. I give permission to representatives of Babson College and Global Program Services to use my name in conjunction with discussions about the international program in which I participate. Such discussions may take place between members of the Babson faculty, administration, staff and/or students. Please initial: I give permission to the representatives of the Babson College Global Program Services to give out my name and contact information to prospective program participants in the event they wish to correspond with me about the program I participate in overseas. Please initial: I give permission to the representatives of Babson College and Global Program Services to send an advising copy of my transcript to faculty chairs (if requested) for purposes of doing course evaluations. Please initial: If studying for a semester or academic year only In addition, by providing my signature, I give permission to representatives of the Office of Student Financial Services at Babson College to forward financial statements (including bills) to the address I list below. I certify that this is the address to which mail should be sent to me during my period of study overseas. I agree to give updated information to the Office of Student Financial Services once my address changes. PLEASE SELECT THE APPROPRIATE PROGRAM AND TERM OF STUDY: PROGRAM TERM OF STUDY Undergraduate semester study abroad Fall semester 0 MBA semester study abroad Spring semester 0 Undergraduate off-shore elective Winter session 0 MBA off-shore elective Summer session 0 Global Management Program (GMP) Spring break session 0 Joint Management Consulting Field Experience (J-MCFE) Spring break session 0 Other: Other: 0 The parties to this Agreement (which is constituted of Forms 1-6, each of which is incorporated by reference) are ( Student ), (Student s parents or legal guardian, if student is under 21, and Babson College ( College ). The Student, with the consent of the Student s parents or legal guardian, has chosen to participate in the program specified above at Babson College (hereafter, Program ) during the [specify dates of Program]. Name Telephone number Relationship to you FINANCIAL RELEASE By signing below, I give permission to authorized representatives of the Office of Student Financial Services to access my account at Babson College and to distribute any credit balances to the address that I provide above. Printed name of student Signature of student Social Security number Assumption of Risk. Student plans to study, intern or travel on the College s international program specified above. Student will complete all forms attached hereto and provide the necessary information as detailed in this packet. Student understands that (i) by participating in a Babson College Program, she/he is subject to both rules and regulations of the host school(s) or host company and of the College regarding conduct and scholarship in the Program and that student will be subject to College disciplinary action up to and including expulsion from the College for violations thereof. Student understands that she/he will be subject to the laws of the country where Student is studying or traveling and agrees to abide by the laws of that country. Student also acknowledges that the College is not responsible for any injury, loss, or damage to Student s person or property whether resulting from acts or omissions of any persons, from the operation or condition of facilities or premises, from acts of war or terrorism or from acts of God or nature; provided, however that this clause shall not apply to injuries or losses caused by criminal conduct or gross negligence of the College s employees. Student certifies that the information on the attached application is correct and agrees to keep it updated as necessary. Student understands and agrees that foreign travel presents risks to Student and her/his property. These can include, among others things: unfamiliar or different terrain, climate, food and drink, customs, laws, social and sexual mores, safety practices and regulations, communications, criminal and law enforcement activities, acts of war or terrorism, or from acts of God or nature; disability access, driving practices, disease risks, and health care. Student is responsible for researching and evaluating the risks she/he may face and is responsible for her/his actions. Any activities that Student may take part in, whether as a component of the Program or separate from it, will be considered to have been undertaken with Student s approval and understanding of any and all risks involved. This includes, without limitation, risks associated with the consumption of alcoholic beverages, use of illegal drugs in any form and injury, or death such as traffic accidents, assault, and theft. Adherence to Standards. Student understands and agrees to abide by all policies, rules, and regulations of the College and the host school(s) or host Company and all rules, regulations, and laws of the countries to be visited. Student further agrees to obey all directives issued by the College or its representatives, by any associated individuals, institutions, or organizations, or by the United States Government. Student specifically understands that consumption of alcohol [by underaged persons or by persons who are 21 years or older] or illegal drugs in any form will not be tolerated. The laws of many foreign countries state that possession or use of illegal drugs is punishable by fine, imprisonment and/or deportation. Termination of Participation. Student shall not engage in inappropriate conduct including the use of physical or verbal violence, open abuse of the customs or mores of the community or unauthorized absences from classes or other activities. Student understands that, in its sole discretion, the College or its representative may terminate Student s participation in the Program at any time, including before departure or during the Program. If Student s conduct or lack of scholarship should cause him or her to be withdrawn from the Program and returned to the College or his/her home, Student agrees to bear the costs of return transportation. Reasons for termination may include, but are not limited to inappropriate conduct or other behavior by Student deemed detrimental to the best interests of the Program, emergencies or health or safety considerations. Such termination shall not diminish or otherwise alter Student s obligation to make any payment required for the Program, nor shall the College be required to make any refund to Student.

3 Release of Claims. In consideration of the College accepting Student into the Program, Student, his/her heirs, executors, administrators, employers, agents, representatives, estate and his/her parents or guardians, hereby release and discharge the College, its officers, trustees, faculty, employees, agents, and representatives (hereafter Released Parties ) from any and all claims which may arise from any cause whatsoever, whether resulting from acts or omissions of any persons, from the operation or condition of facilities or premises, from acts of war or terrorism or from acts of God or nature or risks associated with the consumption of alcoholic beverages, use of illegal drugs in any form and injury or death from causes such as traffic accidents, crime, assault and theft; provided, however that this clause shall not apply to injuries or losses caused by criminal conduct or gross negligence of the College s employees or agents. Student further releases and discharges the Released Parties from responsibility for any accident, illness, injury, or any other consequences arising or resulting directly or indirectly from Student s participation in the Program. The Student recognizes and agrees that the Released Parties assume no responsibility for any liability, damage, or injury that may be caused by Student s negligence or willful acts committed prior to, during or after participation in the Program, or for any liability, damage, or injury caused by the intentional or negligent acts or omissions of any other participant in the Program, or caused by any other person. Indemnification and Hold Harmless. Student, his/her parents and/or guardians, heirs, executors, administrators, employers, agents, representatives and estate, hereby agree to indemnify and hold harmless the Released Parties from and against any loss or liability whatsoever including reasonable attorneys fees, caused by acts or omissions of any persons, from the operation or condition of facilities or premises, from acts of war or terrorism or from acts of God or nature or risks associated with the consumption of alcoholic beverages, use of illegal drugs in any form and injury or death from causes such as traffic accidents, crime, assault and theft; provided, however that this clause shall not apply to injuries or losses caused by criminal conduct or gross negligence of the College s employees or agents. Program Participation. Student understands and agrees to attend and participate in all activities that are part of the Program. Student understands that failure to do so may result in the reduction of grade, including the possibility of course failure, termination from the Program, or both. Financial Obligations. Student understands and agrees to pay College tuition for the study abroad or internship program on the dates that tuition is normally due. Likewise, student agrees to pay any money owed to cover any Program fees (for travel, accommodations, cultural visits and the like) by the date specified by the Program Manager. Student understands that using financial aid to cover tuition and/or Program fees requires communication with the financial aid counselor prior to departure to review any award and sign any necessary paperwork. Student also understands and agrees to abide by the College s refund policies on tuition and Program fees. Activities Outside Program. Should Student choose to remain overseas at the Program location or elsewhere after participation in the Program, the College will cease to act as a sponsor for Student. Should Student leave the Program, voluntarily or involuntarily, the College will cease to act as sponsor Student thereafter. In either of the foregoing events, the provisions of this Agreement shall remain in full force and effect. Program Modification and Cancellation. The College reserves the right to cancel or modify the Program before or during its operation due to circumstances including emergencies, low enrollment, unavailability of one or more facilities or personnel or other reasons. Severability. It is understood and agreed that, if any provision of this Agreement or the application thereof is held invalid, the invalidity shall not affect other provisions or applications of this Agreement which can be given effect without the invalid provisions or applications. To this end, the provisions of this Agreement are declared severable. Governing Law; Venue. This release shall be construed in accordance with, and governed by, the laws of the Commonwealth of Massachusetts. We agree that venue for any dispute arising under this Agreement shall be Norfolk County, Massachusetts. Construction and Scope of Agreement. The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any party. This Agreement is the only, sole, entire, and complete agreement of the parties relating in any way to the subject matter hereof. No statements, promises, or representations have been made by any party to any other, or relied upon, and no consideration has been offered or promised, other than as may be expressly provided herein. This Agreement supersedes any earlier written or oral understandings or agreements between the parties. I here by acknowledge that I have been provided an opportunity to read this document, to consult with an attorney or advisor of my choosing, that I am fully aware of its legal effect that I am executing it of my own free will and that in doing I have not been subjected to any form of coercion or duress by and members of the College Student signature Parental signature (if student is under 21) NOTARIAL ACKNOWLEDGMENT COMMONWEALTH OF MASSACHUSETTS On this day of, 200, before me, the undersigned notary public, personally appeared, proved to me through satisfactory evidence of identification, which were, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that (he) (she) signed it voluntarily for its stated purpose. Notary Public Printed name of Notary Public: My Commission expires: PASSPORT INFORMATION If you do not have a passport or did not complete this form as part of your application, please complete and return this form as soon as you have received your passport. Please note that passports are required to apply for student visas, so make sure to process your passport applications as soon as possible. Name as it appears on passport Country Passport number of issuance Place of issuance of expiration (This date must be at least six months after the program completion date.) Form 5 YOU MUST ATTACH A PHOTOCOPY OF THE FIRST PAGE OF YOUR PASSPORT, SHOWING YOUR PERSONAL DATA.

4 INSURANCE INFORMATION Form 4 ACKNOWLEDGEMENT OF BABSON COLLEGE S OVERSEAS PROGRAM CANCELLATION POLICY Form 2 Massachusetts law and Babson College require all students enrolled in a Babson College international program to carry adequate medical insurance coverage. Please complete all questions below. Please indicate the medical insurance coverage you will be carrying for the above academic period: Babson College s Medical Insurance Plan: (check one below) YES NO Babson College ís student health insurance will cover you anywhere in the world from approximately August 18 to August 18 of the following year (or January 18 to August 18 for semester participants). If you indicated yes, and your program begins before the August 18 or January 18 insurance start date, you must inquire about purchasing additional insurance through Babson College for the portion of the program before. If no, please complete the waiver section below. BABSON COLLEGE MEDICAL INSURANCE WAIVER Insurance carrier Policy number Duration dates of policy Name of subscriber Relationship to student (indicate yourself if you are the subscriber) I certify that I/my son/my daughter/spouse will maintain enrollment in the above medical insurance plan from the start of the Program through the end of the Program. I certify I have compared it with the Babson College Student Insurance Plan and determined the benefits to be comparable. I understand that neither Babson College nor its student medical insurance plan will be responsible for my/my son s/my daughter s/spouse s medical expenses. I acknowledge I am legally responsible for all medical insurance expenses incurred by myself/my son/my daughter/spouse. I certify that this information is true and accurate. I understand that although the College will attempt to maintain the Program as described in its publications and brochures, it reserves the right to cancel or change the Program for any reason. Decisions to suspend or cancel a Program abroad are made by Program staff, the faculty director(s), the Program dean, and the Office of Student Affairs staff. The Babson administration may rely on several information sources in its decision-making including in-country Babson staff, officials at partner institutions, the State Department, and other governmental officials. Such a decision is dependent on a number of factors including, among others: 1. Minimum enrollment levels for Babson-sponsored short courses. (Babson-sponsored short-term academic programs normally require a minimum enrollment of 15 students at the registration deadline and thereafter. This enrollment figure may be reviewed on a case-by-case basis depending on the program details.) 2. Conditions in-country or surrounding areas. Cancellation policy with regard to tuition/program fees is as follows: 1. If Babson cancels a program prior to its commencing either on-campus or overseas, the College will provide a refund of tuition fees paid to Babson. Refunds of program fees (including airfare) is limited by nonrecoverable contractual obligations. 2. If Babson cancels a program after it has started: Refunds of program fees (including airfare) may be limited by nonrecoverable contractual obligations. Refund of tuition fees will depend on how much academic credit the student in the program will still be able to receive for work already completed or to be completed through alternative arrangements. Babson will attempt as far as possible to arrange with faculty and departments suitable alternatives to completing planned academic work for credit. 3. If Babson does not cancel a program but a student chooses to withdraw from a program for any reason, program staff will handle the situation on a case-by-case basis regarding refunds. The student will be responsible for covering all non-recoverable contractual obligations. I hereby acknowledge that I am fully aware of the aforementioned cancellation policy, and that I am signing it of my own free will. Policy holder signature Student signature Parent or legal guardian signature (if student is under 21)

5 EMERGENCY CONTACT AND MEDICAL CARE AUTHORIZATION FOR STUDY ABROAD PROGRAMS Form 3 PARENTAL CONSENT Form 3a Person to be contacted in case of emergency Name(s) Relationship Day telephone Evening telephone In the event of an emergency, Babson College, acting by and through the faculty adviser or appropriate administrative officer will use good faith efforts to reach the individual designated as an emergency contact before using the authorization below. However, in case of an emergency, your signature on this optional authorization may assist in obtaining necessary medical care. To prevent dangerous delay in the event of an emergency requiring hospitalization and/or surgery, I hereby authorize the faculty adviser designated below, or if no faculty advisor is so designated, the administrator and staff of the institution or company which hosts the program (each, an Attorney ) to secure whatever treatment is deemed necessary including the administration of an anesthetic and/or surgery and I hereby execute and deliver the following Emergency Power of Attorney and Consent to Medical Treatment: The undersigned hereby certifies that I am the parent or legal guardian of, the student signing the foregoing Emergency Power of Attorney and Consent to Medical Treatment and Waiver of Liability, Covenant, Release and Hold Harmless Agreement relating to the student s participation in the international program sponsored by Babson College ( Program ). I request that the student participate in the Program, and do hereby request that the College, through its faculty advisor, if any, or the officers and employees of the host institution take whatever steps are necessary to secure medical treatment for the student in the event he/she appears to need such treatment while participating in the Program. I consent to the rendering of all necessary medical treatment, including admission to a hospital or other health care facility at such places as the College, acting through its faculty advisor, if any, or the host institution, acting through its officers and employees, deems best. I authorize the faculty adviser or other agents or employees of the College or host institution to authorize whatever treatment and execute whatever forms which may be necessary to insure medical care for the student. I do hereby join in and consent to the Agreement and the Power of Attorney, the terms of which are incorporated herein by reference, and agree to indemnify, defend and hold the College and its trustees, officers, employees, agents, and representatives harmless from and against any demand, loss, cost, damages, action or cause of action, including, without limitation, reasonable attorney fees, which the student or the undersigned may suffer or incur as a result of, in connection with, or arising from the student s participation in the Program. Signature of parent or legal guardian Emergency Power of Attorney and Consent to Medical Treatment Effective at all times during which I am participating in the Program (including travel to and from the departure and return points), I hereby appoint the Program s faculty adviser or in the faculty adviser s absence (or if there is no faculty adviser from the College), any officer or employee of the host institution or company, acting individually, to act on my behalf as my Attorney and to seek and obtain on my behalf and at my expense, any medical treatment or emergency medical treatment, which in the sole discretion of any such attorney, is or may be necessary or advisable as a result of any accident, injury or medical condition affecting me during the Program or during travel to, from or during the Program. I hereby consent to and request that such Attorney seek and obtain any such medical assistance for my benefit and at my expense in the event of any such accident, injury, or medical condition. I hereby authorize all physicians and other medical care providers, including hospitals, to provide medical care to me in accordance with the directions of such Attorney. I hereby agree to indemnify, defend (with counsel reasonably acceptable thereto) and hold harmless the Attorney, and any person acting at the request of any Attorney pursuant to this Power of Attorney, from and against any loss, claim cost, action, damage or cause of action resulting from or related to the taking of any action, or provision of medical care or treatment hereunder. This Power of Attorney shall not be affected by my subsequent disability or incapacity for any reason. Printed name of parent or guardian Telephone number REFUSAL OF MEDICAL TREATMENT AUTHORIZATION FORM I hereby request that any Attorney taking action hereunder notify my parent or guardian of the same as soon as possible. The Attorney should not delay obtaining any necessary medical treatment while seeking to notify my parent or guardian. I hereby acknowledge that I am fully aware of the aforementioned Emergency Contact and Medical Care Authorization and that I am signing it of my own free will. I voluntarily and knowingly choose not to authorize anyone other than the person named as my Emergency Contact to secure emergency medical treatment on my behalf. I fully recognize that delay in obtaining necessary medical care may lead to adverse medical consequences and complications, including death. Signature Signature Signature of parent or legal guardian (if under 21)