Instructions: 2. a copy of passport. 3. a completed "Project Abroad" form. 4. a completed "Assumption of Risk and Release" form

Transcription

1 Instructions: The following documentation needs to be submitted to the International Programs Office (Liberal Arts Building, Room 016) for approval of international travel supported by the University: 1. a coversheet which includes full name, student ID number, passport country and number, visa information, and emergency contact information. The same coversheet should contain a description of the program/activity/conference the student will be attending or participating in, the travel schedule (itinerary), and at least one 24/7 contact telephone number in the destination country. 2. a copy of passport 3. a completed "Project Abroad" form 4. a completed "Assumption of Risk and Release" form 5. a "Travel Warning Country Release" form

2 Here is an example of completed cover sheet: International Student Travel Documentation Cover Sheet Name: Joe Schmoo Student ID # Passport Country: United States Passport Number: Visa Information: If a travel visa is required, name of issuing country: France (or could be not applicable dependent upon individual circumstances consult with the Office of International Programs for information as necessary) Emergency Contact in US: Julie Schmoo Attendance and presentation at the World of Animal Kingdom in Paris, France (name of conference and conference site) Departing on Returningpm : Monday, February 1, Logan International Airport, Boston, MA connecting through New York, NY to Charles de Gaulle Airport, Paris, France Saturday, February 13, 2016 Charles de Gaulle Airport, Paris, France connecting through New York, NY to Logan International Airport, Boston, MA Travel itinerary with airline and flight details attached. Contact in destination country: Jane Doe conference coordinator Accommodations: Viva La France Hotel 285 Rue de Old Wesport Paris

3 International Student Travel Documentation Cover Sheet Name: Student ID # Passport Country: Passport Number: If a travel visa is required, name of issuing country: Visa Information: Emergency Contact in US: Attendance and presentation at (name of conference and conference site) Departing on Returning on: (day, date and time) (day, date and time) Travel itinerary with airline and flight details attached. Contact in destination country: Accommodations:

4 UMass Dartmouth Project Abroad Registration Form (non-credit) Name: Academic Department: Dates of Proposed Travel: Travelling alone? Y/N If not, name/description of group: Description of Project/Program/Conference: Name of any host organization or affiliated institution: Name of UMD Faculty or Staff Advisor/Coordinator: If student group - Name of Asst. Leader (UMD Faculty, Staff, Grad Student): Prior to departure: Have this form signed and attach the following before submitting to the International Programs Office, LARTS 016: 1) Participant full name/s, passport country/number, emergency contact info, student id number (clearly note any non-student participants). 2) Signed waiver form for each participant (see SAIL Assumption of Risk and Release) 3) Goals of program and brief description 4) Site and facility description 5) Outline of day by day itinerary 6) Accommodations (name, address, contact name, telephone and ) 7) Plan for meals, transportation, health/safety 8) 24/7 telephone number in case of emergency For one student travelling alone: Signature Date For Leader of student group: I accept responsibility for 1) adhering to academic and disciplinary policies of the university and 2) for 24/7 oversight of student support and advising throughout the program dates. Leaders are expected to carry a mobile phone at all times for urgent access by students on-site or university representatives. A signature acknowledges that responsibility: Leader signature Date By signing the Dept. Chair or Faculty/Staff Club Advisor acknowledges review of the attached materials, support for the program concept and design as outlined. Chair or Advisor Name: Date Signature: Dean/Asst. Vice Chancellor/other Sr. Administrator Name: Date Signature: Reviewed Provost Signature: Date 16sept2015kk

5 Assumption of Risk and Release (Field Trips and Off-Campus Activities) I,, am (check one) eighteen (18) years of age or older; under eighteen (18) years of age and have voluntarily applied to participate in (hereinafter the Event ) at on. I acknowledge that the nature of the Event may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. Further, I hereby certify that I have health and accident insurance with, policy number, which will cover me on this trip. Participant Name STUDENT ACTIVITIES, INVOLVEMENT & LEADERSHIP Location Company Name Date of Activity In consideration of my participation in the Event, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release, discharge, and covenant not to sue, the University of Massachusetts Dartmouth (the University ), and its Board of Trustees, officers, employees and representatives from any liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Event, whether caused by negligence of the University, its Board of Trustees, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the University and its Board of Trustees, officers, employees, and representatives from and any all claims, liability, damages, loses, or expenses (including attorney s and expert s fees) arising out of or resulting from the injury or death of any person(s) or damage to property that may result from my negligent or intentional act or omission while participating in the described Event. BY SIGNING BELOW, I ASSERT THAT THE STATEMENTS MADE HEREIN ARE TRUE AND THAT I HAVE CAREFULLY READ THIS ENTIRE AGREEMENT AND UNDERSTAND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT MAY OCCUR WHILE PARTICIPATING IN THE DESCRIBED EVENT AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. Activity Participant Signature Date Participant Cell Phone Number Participant Address Signature of legal guardian if participant is under 18 years of age In case of emergency, please contact: Name: Relationship: Phone #: For Office Use Only: Ticket #: Trip Sponsor: Address: Sold by: Contact: This form will be kept on file in the SAIL Office until the conclusion of the trip.

6 INTERNATIONAL TRAVEL REGISTRATION FORM for countries under US State Department Travel Warning or Travel Advisory In compliance with UMass travel policy, anyone traveling under University of Massachusetts Dartmouth auspices must complete this travel registration form. The information provided is needed for UMass-sponsored Chartis International travel insurance, which covers everyone traveling in connection to their work or study at UMass, and to help us provide assistance should emergencies arise during travel. *Indicates a required field TRAVELER INFORMATION Full Name* Academic Department* * Student ID* Destination (City, Country)* Departure Date* Return Date* Program/Course No.* UMASS DARTMOUTH INTERNATIONAL TRAVEL LIABILITY RELEASE STATEMENT I understand that there are dangers and risks to which I may be exposed by participating in international experiences and travel. I understand, accept, and assume any and all risks associated with these activities, including but not limited to, illness, accidents, violence, or death, all such risks being known and appreciated by me. I further understand that other countries enforce different laws, regulations or standards, including but not limited to, those relating to health, welfare, safety, crime, regulation of businesses and transportation in any form. I agree to be bound by same. As part of the consideration for participating in this program and related travel, I am fully aware of the US State Department Travel Warning and Travel Alerts, as well as the Centers for Disease Control Travel Health Notices pertinent to the country or region to which I am traveling. I have carefully considered described warnings and acknowledge that at any time warnings may become of a more urgent matter. I acknowledge that I am not required to participate in this activity and have elected to do so knowingly and voluntarily with full knowledge of all potential risks/dangers.

7 I agree to accept, assume, and take upon myself, all risk and responsibility in any way associated with this travel and related activities. In consideration of the services, assistance, and facilities provided by the University of Massachusetts Dartmouth for these activities and travel, I agree to release, discharge, indemnify, defend, and forever save free and harmless UMass Dartmouth (its Trustees, officers, employees and agents) from and against any and all liability, claims, damages, or actions (including reasonable attorney s fees and costs) arising from and/or related to my injury, illness, or death, or damage to my property, or any other claims, actions, and disputes whatsoever, which arise from and/or relate to my travel and associated activities. I understand that this Release covers liability, claims, actions and damages that may be caused by, or result from, in part, certain acts or omissions by UMass Dartmouth (its Trustees, officers, employees, or agents), including but not limited to, negligence, mistake, or failure to properly supervise and train or any other conduct by UMass Dartmouth. I recognize that this Release means that I and anyone else on my behalf are giving up, among other things, rights to sue UMass Dartmouth, its Trustees, officers, employees, and agents for any illness, injuries, death, damages, or losses I may incur as a result of my participation in this travel and associated activities. I understand that this Release also binds my heirs, executors, administrators, and assigns, as well as me. I have read and understand this Release, and I agree to be legally bound by its terms and conditions. Your signature below confirms agreement with the above. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Students and other participants are required to complete the following. Although highly recommended, the following actions are not required of faculty/staff. Consult US State Department Travel Warnings/Alerts ( ) and CDC Travel Health Notices for travel advice and entry/exit requirements ( ). Obtain travel approval from UMass Dartmouth s International Programs Office if traveling to a country or region with a Warning or Alert, even if outside the published group itinerary. Obtain current travel health information and necessary vaccines & medications as recommended by CDC (above). Register travel with the US State Department through the Smarter Traveler Enrollment Program ( ). Upon completion of this travel registration form, you will be covered by UMass international travel insurance. Student Signature Date Print Name

8 University of Massachusetts Dartmouth International Programs Office 016 Liberal Arts Building Tel: