This is a legally binding release made by the participant, who hereby declares to be 18 year old or older. The term "Undersigned" is used in this agreement as pertaining to more than one person.
I. PROGRAM
Participant desires to take part in the following program.
Name of Program: Rome Institute of Liberal Arts (hereafter, RILA)
II. WAIVER
The Undersigned fully understands that there are certain dangers, hazards, and risks inherent in international travel, and have signed this document in full recognition and appreciation of the dangers of these activities, which dangers include, but are not limited to, physical injuries (minimal, serious, catastrophic), death, and/or property loss or damage.
The Undersigned therefore agrees to assume and take on all responsibilities in any activities associated with RILA's program in Italy. In consideration of, and in return for, the service, facilities and other assistance provided to participants by RILA (and their governing boards, employees, and agents) I, along with any of my assignees, heirs, distributes, parents guardians, and legal representatives release RILA and its Italian institutions from any and all liability, claims and actions that may arise from injury, harm or death to the Undersigned and from loss or damage to the Undersigned's property in connection with these activities. The Undersigned understands that this release covers liability, claims and actions caused entirely or in part by any acts
or failure to act by RILA, including but not limited to negligence, mistake, or failure to supervise by the RILA or any of their employees, agents, or contractors.
III. HEALTH INSURANCE AND MENTAL HEALTH CONDITIONS
a. MEDICAL INSURANCE
It is important to realize that most U.S. insurance coverage is not recognized overseas.
The Undersigned will normally pay for medical service and fill out a claim form to be returned to the home company for reimbursement. It is imperative for the Undersigned to know the limits of their coverage and to carry at least one claim form to be signed by the appropriate medical persons abroad to facilitate reimbursement. The Undersigned may wish to purchase emergency evacuation and repatriation insurance before they begin their program abroad. It is the Undersigned’s responsibility to ensure that he/she has health and/or hospitalization insurance, which is applicable in countries other than the United States.
b. ACCESS TO MENTAL HEALTH TREATMENT
RILA does not employ or retain mental health professionals abroad. If an Undersigned is experiencing emotional or other personal problems that may require medical or mental health treatment, the Undersigned should consult with their current mental health provider prior to engaging in RILA’s programs to discuss the potential stress of traveling/studying abroad.
The Undersigned should know that mental health treatment and prescription medicine may not be as easily accessible in Italy as it is in the United States. RILA strongly urges the Undersigned to bring any prescription medications they expect to need with them to Italy.
IV. PHOTOGRAPH RELEASE
By signing this form, I hereby grant full and irrevocable consent to release, at any time, present or future, any voice recordings, photographs and/or video footage, for commercial and art purposes in any advertising, communication, publication or publicity related to RILA, alone or with other persons, objects or text material, and either with or without name recognition.
V. CONDUCT / BEHAVIOR RELEASE
I understand that RILA must take steps to ensure that no offensive, disruptive or potentially dangerous conduct occurs. Accordingly, RILA reserves the right to dismiss an Undersigned from the program on the basis of any observed conduct or behavior that causes concern for the safety and well being of others. RILA directors shall have the authority to make the final decision on a participant's dismissal from the program. Misconduct includes actions that violate RILA regulations or Italian law, or in the judgment of RILA officials, jeopardize the welfare of the Undersigned, other individuals or the program. It is understood that no refund of fees or rent will be given if an Undersigned is dismissed from the program. Such actions include, but are not limited to, the following:
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The use of threats or physical violence
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Violation of Italian laws
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Violation of the office or housing regulations
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Damage to or destruction of classroom, residence, or participants' property
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Alcohol or substance abuse
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Reckless or dangerous behavior
I, the Undersigned, have carefully read this release and fully understand its contents. I am
aware that this is a Release of Liability and a Contract between me and RILA, and sign it
of my own free will.