ACKNOWLEDGEMENT OF RISK FOR RMC OFF-CAMPUS AND STUDY ABROAD PROGRAM PARTICIPANTS

*required field
I, *______________________ (RMC Email Address:
*________________________ Student ID #: ____),
a participant (the “Participant”) at Randolph-Macon College (the “College”), desire to participate in a program abroad or off-campus (the “Program”) taking place during the term(s) and year(s) corresponding to RMC’s academic calendar:
*______________ (term/s)/____ (year/s). I realize that if I do not sign this form, and comply with all its terms, I will not be permitted to participate in the Program. Some programs carry academic credit, and I understand that the requirements to receive academic credit are different from the requirements to travel off campus. In consideration for my participation in the Program, I understand and agree that my participation in the Program is subject to the following terms:

1. Academic Work/Personal Conduct

  • I understand, acknowledge, and agree that participation in this Program is not required as part of my academic or other responsibilities at the College and that my participation in this specific Program is voluntary and solely for my benefit.
  • I understand and acknowledge that Randolph-Macon College reserves the right to exclude any participant from any program on account of unsatisfactory academic work or an unsatisfactory student conduct record prior to departure. I therefore understand that Randolph-Macon and the Program may terminate my participation in the Program up to the day of departure if I fail to meet any such standards. I further acknowledge that if my participation in the Program is terminated due to a failure to meet required academic or conduct standards, there may be no refund of any expenses paid.
  • The U.S. Department of State advises all travelers that, while in a foreign country, one is subject to that country’s laws. I understand that if my off-campus program includes an international component I am subject to the laws of the countries in which I will travel and that it is my responsibility to familiarize myself with those laws. Visit https://travel.state.gov/content/passports/en/go.html for detailed information about your destination(s).

2. Conduct Agreement and General Acknowledgement of Risk

  • Conduct Agreement: Having been made aware of my obligation to do so, I agree to abide by Randolph-Macon College’s Code of Student Conduct in addition to any additional applicable laws and policies in effect in the host destination and at the host institution and sites. When off-campus/international travel is undertaken under the leadership of a Randolph-Macon College faculty instructor or staff member who is leading the Program (the “Instructor”) I understand that the instructor has the full authority to act on behalf of the College in enforcing rules and policies suitable to making the educational experience worthwhile for all concerned. I further understand and acknowledge that when I am participating in a program sponsored by a third party, Randolph-Macon may be unable to intervene on my behalf and I will be subject to disciplinary action that may be different or more severe than the penalties Randolph-Macon would impose for similar conduct. I acknowledge that disciplinary action may include termination of my participation in the Program, in addition to any provisions stated in the Code of Student Conduct.
  • Acknowledgement of Risk: I understand that, by participating in the Program I am choosing to participate in travel, living arrangements, and other activities as coordinated by the Program. I acknowledge that such participation could entail a heightened risk of danger to me because of transportation to and from the offcampus/overseas locations and because of circumstances that are likely to be different from those typical on the Randolph-Macon College campus. I further acknowledge that the College and its employees, agents, successors, and assigns cannot guarantee my safety from bodily or other personal injuries, accidents, sicknesses, illnesses, diseases, medical treatments; nor can it guarantee protection from (i) disciplinary actions taken by the Program or the College which affect my participation in the Program or (ii) any injury or loss, including loss or damage to personal property not covered by insurance that may result from, arise out of, or in any other manner is connected with my participation in the Program including, but not limited to (i) my air, railroad, bus or other transportation or travel resources; (ii) my receipt of medical treatment arranged or sought on my behalf; (iii) delays or changes in air, railroad, bus, or other transportation or travel services or hotel or lodging accommodations; (iv) any ticket or coupon issued or arrangements made for air, railroad, bus or other transportation or travel services or hotel or lodging accommodations; and (v) weather, strikes, terrorist attacks or incidents, war or other civil, national or any other violent or non-violent disturbances.

    In order to participate in the Program, I am willing to assume these additional risks which may include but are not limited to increased risks of disease, foodborne illness, poor health or sanitary conditions, and security risks including but not limited to terrorism and/or other criminal conduct.
  • Applicability: This acknowledgement applies to both the Program and to any voluntary deviation from the Program’s planned activities, including, but not limited to, a decision not to return to the United States and/or to the Ashland campus in accordance with the Program’s planned or adjusted return travel arrangements or a decision to travel outside the United States before or after the Program’s official start and/or end dates. The College or the Instructor does not assist participants with extending their stays overseas, planning or taking excursions away from the Program’s campus or site, nor does it track information about participants’ itineraries during, or after the completion of, the Program. Should you leave the Program, travel away from the Program’s location, or elect to extend your travel, the College is not responsible and insurance coverage that you have purchased for the Program may not be applicable. Students are urged to purchase insurance coverage for the entire duration of their stay abroad.

I grant Randolph-Macon College and its agents, both foreign and domestic, permission to communicate personal information about me to my parents or guardians, or other third parties listed on my emergency contact form, in the following circumstances while I am participating in the Program:

  • medical conditions
  • psychological conditions
  • legal issues
  • academic issues
  • behavioral issues
  • financial issues
  • missing person status or concern about my whereabouts
  • Any other conditions or situations which in the College’s judgment suggest such communication is warranted.

4. Privacy Act Waiver for U.S. Department of State (only applicable to international programs)

The U.S. Department of State can only provide very limited information about U.S. citizens to third parties without a written Privacy Act Waiver. This means that if a U.S. citizen does not sign a Privacy Act Waiver and agree to the release of information about his or her whereabouts, the U.S. Department of State and U.S. embassies and consulates abroad cannot release that information unless one of the Act’s conditions of disclosure applies [that is, unless one of the conditions of the Privacy Act allows release of information, without a signed waiver, to specific persons and groups and only under certain circumstances]. If there is no Privacy Act Waiver, the State Department can simply confirm whether or not they were able to contact the individual, but cannot provide other information.

In light of this information, I authorize the U.S. Department of State, including but not limited to the Overseas Citizens Services, the Bureau of Consular Affairs, and U.S. embassies and consulates abroad, to release information about me, my welfare, and my whereabouts to Randolph-Macon College and its agents, both foreign and domestic, including but not limited to the following offices of the College:

  • Provost’s Office
  • Dean of Students
  • Office of International Education (OIE)
  • Campus Safety
  • Instructor(s) of the Program in which I am enrolled/participating

5. Medical Insurance

I understand and acknowledge the importance of having medical insurance coverage while traveling, and acknowledge that:

  • Randolph-Macon College mandates that all RMC participants (enrolled students, faculty instructors and chaperones) in the College’s faculty/staff-led programs abroad be enrolled in the Comprehensive Ultimate Plan provided through iNext International Insurance, when applicable (for more details, please visit: https://gormc.sharepoint.com/sites/oie/SitePages/Mandatory-Insurance- Plan.aspx).
  • When the purchase of iNext International Insurance is not required (for example, in the case of semester study abroad programs), the College strongly encourages participants to have valid health insurance. Health care expenses, including medical evacuation, are the responsibility of the Participant. It is essential that all Participants in off-campus/overseas programs offered through the College have insurance coverage that is valid in the locations in which they will be traveling, and that Participants are familiar with what their insurance policy covers and how to access medical services if they are needed. Participants in domestic study- travel without adequate health coverage in the U.S. participate at their own risk and expense.
  • Access to medication can be difficult when traveling. Participants are strongly encouraged to (i) bring an ample supply of medication to cover the length of travel, (ii) carry a letter from a physician that describes their medical condition and any prescription medications, including the generic name of prescribed drugs, (iii) keep medications in their original, labeled containers, and (iv), when applicable, to check with the foreign embassy of any country you will visit to make sure your medications are permitted in that country. Randolph-Macon College is not responsible for ensuring that your medications are legally permitted in your destination country(-ies), nor can its employees provide advice relating to medication needs. The U.S. Department of State website makes available detailed information about medical and health concerns while abroad: https://travel.state.gov/content/travel/en/international-travel/before-you- go/your-health-abroad.html.
  • Because travel planning carries inherent uncertainties and particularly in light of the uncertainties related to infectious diseases such as COVID-19, participants are strongly encouraged to purchase an insurance policy that will cover cancellation for any reason as part of their planning for travel. The iNext Comprehensive Ultimate Plan does not provide cancellation-for-any-reason coverage.

6. Cancellation and Refund Policy

Randolph-Macon College (the College) reserves the right to make cancellations, changes or substitutions to its Program at any time. The College shall not be liable for any loss whatsoever to program participants as a result of changes or cancellations due to a Department of State travel warning, border closures, disease spread, hostile activity, acts of war or terrorism, or in the event of social or civil unrest, a natural disaster or a similar emergency either in the U.S. or abroad. In the case of an internal unforeseen circumstance, such as a health crisis of the instructor, the College will use its best efforts to reimburse any recoverable costs of the program from insurance and other third parties and will make a reasonable effort to provide some form of substitution. To review more details about the cancellation and refund policy for study-travel courses, please visit the OIE’s website (https://www.rmc.edu/study-travel/cancellation-refund-policy). For other programs, participants must refer to their program provider’s and/or host institution’s information directly and follow their policies.

Additionally, students whose conduct is disruptive of any off-campus or study abroad program may be sent home at their own expense. In such cases, the student will fail the course/program and will not receive a refund.

7. Acknowledgement of Risk due to Infectious Disease (including COVID-19)

Randolph-Macon College (RMC) requires that you acknowledge additional risks and any policies and procedures aimed at securing the health and safety of students and faculty as well as our in-country hosts and the local people encountered during travel. All participants are responsible for ensuring that they understand and meet each destination country/host site’s entry requirements and health guidelines. Additionally, it is the participant’s responsibility to understand and comply with the United States entry requirements. The College is not responsible for any requirements or restrictions within the destination country(ies) or in the United States. The College has no control over the requirements of the destination country(ies), the enforcement of these requirements, nor the ramifications for failing to comply with these requirements. Any expenses the Participant incurs for testing and/or quarantine/isolation to comply with entry requirements or health guidelines will be at the Participant’s own expense. Any such expenses incurred by the Participant but paid by the College due to the participant’s incapacitation during travel will be charged back to the student account. In all situations, all participants should self-monitor their health condition to protect the health and safety of their fellow travelers and people of their host country(ies)/sites.

BY SIGNING, I acknowledge that I have read and understand the information contained within this document, especially pertaining to my responsibility to inform myself of: all requirements for travel to the destination country(ies); all requirements for returning to the U.S; of the limitations of the College’s mandatory insurance coverages; and of the risk that I may be financially responsible for testing and quarantine/isolation costs. Additionally, I acknowledge that I am giving up legal rights and remedies that may otherwise be available to me. I acknowledge that I have the right and opportunity to consult with an attorney or other advisor of my choice prior to signing this Acknowledgement of Risk. I further declare that I would like to proceed with my travel plans.

Participant’s Name (please print)*:                                                                     

Participant’s Signature*:                                                                                    

Date*:                                                                                    

By signing this form, you do affirm that you are the person whose signature appears above and that all information provided within this form is true and accurate.

A parent or legal guardian’s signature is required only if the participant will be under eighteen (18) years of age.

I agree that I have carefully read and understand this agreement, I agree to all the terms above, both personally and on behalf of the minor participant, and I hereby assume the risk that the minor participant may be injured while participating in the Program. I further promise to take reasonable steps to ensure the minor’s compliance with the terms of this agreement.

Parent’s Name (please print):                                                                            

Parent’s Signature:                                                                                    

Date:                                                                                    

By signing this form, you do affirm that you are the person whose signature appears above and that all information provided within this form is true and accurate.