Name * Your email *
What type of program are you participating in? * Group Program # * Open Group Program Name * Program Site * Appalachia Atlanta Bolivia Brazil Ecuador Ghana Italy Jamaica The Navajo Nation New Orleans Northern Ireland Pine Ridge Pittsburgh Poland Puerto Rico Spain Tanzania Trinidad & Tobago Washington, D.C. Age of Participant Amizade Program Participation Assumption of Risk, Waiver and Release Agreement
By agreeing to your Amizade, Ltd. (“Amizade”) acceptance package, you are voluntarily participating in an Amizade program and understand and agree that:
Amizade is not responsible for accidents, delays, incidents, injury, or additional expenses that arise due to the COVID-19 novel coronavirus.
Additional expenses Amizade is not responsible for can include, but may not be limited to, visa application costs, return airfare due to program suspensions or interruptions, housing and meal expenses beyond the last day of your program, COVID-19 testing expenses, costs due to quarantines, and any other expenses not covered by insurance.
You are making the decision to participate in your Amizade program following a review of current travel guidance and your own independent investigation and assessment of the potential risks of traveling during the COVID-19 pandemic.
You expressly agree to review and follow any health and safety recommendations and/or guidance provided by Amizade and/or your home institution during your program.
Amizade is not financially responsible for any disruption of travel caused by COVID-19 novel coronavirus or other unforeseen events beyond Amizade’s control.
You understand that your educational course may change depending on the health and safety determination of Amizade and your home institution.
Any travel within or out of your host country during your program dates that is not sponsored by Amizade is by nature independent and at your own risk and discretion. You agree to follow all guidance and policies provided by Amizade and your home institution, as well as any applicable laws, rules and/or regulations, on regional and local travel.
If you are not able to access your belongings due to travel restrictions, Amizade is not responsible for the coordination or cost of returning these items.
While traveling, public health and safety measures may be implemented by the country you are residing in, of which Amizade has no control.
You are responsible for maintaining open communication with your home institution and Amizade for the entirety of your pre-departure and program dates. Important information will be shared throughout, related to health and safety, particularly related to the COVID-19 novel coronavirus. If a response is requested, it is important for you to respond in a timely manner.
While traveling, the government of your country of citizenship may not be able to assist you in an emergency.
You have thoroughly read and understand exactly what Amizade’s required health and emergency insurance does and does not cover.
Amizade assumes no responsibility for providing medical care during your program.
You agree to prepare for the program by familiarizing yourself with the materials provided by Amizade. This includes following conditioning suggestions and bringing appropriate clothing and equipment.
You understand that participation in any Amizade program is completely voluntary and involves risks inherent to traveling within our country or to another country.
You understand that completion of the Health Declaration Form is required to participate in this program.
You understand that you must provide results of a negative COVID 19 test administered no more than 72 hours prior to departure to participate in this program.
You have read and understand the information provided below in ”Appendix A: Amizade’s Health and Safety Policy”.
You have read and agree to the information provided below in ”Appendix B: Amizade’s Group Conduct Agreement”.
You have read and fully understand Amizade’s withdrawal policies provided below in “Appendix C: Withdrawal and Cancellation Policy”
COVID-19 ASSUMPTION OF RISKS:
I am voluntarily participating in the Amizade travel program. I understand that while Amizade and the home institution have undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with the program, Amizade and the home institution are not responsible in any manner for any risks related to COVID-19 in connection with the program. I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in significant personal injury or death. I am fully aware that participation in the Amizade program (including any related travel) carries with it certain inherent risks related to COVID-19 transmission (“Inherent Risks”) that cannot be eliminated regardless of the care taken to avoid such risks. Inherent Risks may include, but are not limited to, (1) the risk of coming into close contact with individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly from COVID-19 or the treatment thereof. Further, I understand that the risks of COVID-19 are not fully understood, and that contact with, or transmission of, COVID-19 may result in risks including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered Inherent Risks. I hereby voluntarily accept and assume all risk of loss, personal injury, sickness, death, damage, and expense arising from such Inherent Risks.
LIMITATION OF LIABILITY OF AMIZADE:
Amizade gives notice that the services provided in connection with our programs are rendered by suppliers and independent contractors who are not agents nor employees of Amizade. Amizade will endeavor to make arrangements for accommodations, meals, tours, transportation, and/or related travel services in conjunction with our programs. While we endeavor to engage the services of reputable suppliers or contractors, the trip member expressly agrees that Amizade shall not be liable for any delay, mishap, inconvenience, irregularity, or bodily injury, death to person, or damage to property occasioned through the negligence (but not willful or fraudulent conduct) or default of any company or individual, including Amizade, engaged in providing these arranged services. Each passenger conveyance, tour company, hotel accommodation, restaurant, etc. is subject to the laws of the country in which the service is rendered. Amizade shall not be liable, directly or indirectly, for bodily injury, property damage or loss, or additional expense incurred for any reason whatsoever, including, but not limited to the following causes: acts of God, detention, annoyance, strikes, pilferage, theft, weather, quarantines, civil disturbances, default, changes in government regulations or restrictions, terrorism, war, the failure of any means of conveyance to arrive or depart as scheduled, or discrepancies or changes in transit or hotel services. Amizade reserves the right to take photographic or film records of any of their trips, and may use any such records, without trip members consent, exclusively for Amizade promotional and/or commercial purposes. Specifically, the participant grants Amizade the right to use (royalty fee) the use of his/her image, likeness in photograph, video, or digital format for promotional, educational, marketing, or commercial use.
Each participant understands that he or she may come into contact with hazardous conditions during travel, including viruses (e.g., SARS, Coronavirus, Ebola, influenza, yellow fever, malaria), sickness, bacteria, pathogens, and likewise or similar that could cause the participant to become ill or sick or suffer any damage or injury. Each participant assumes this risk of coming into contact with and/or falling ill from and/or suffering damage or loss from any of the aforementioned viruses, sickness, illness, bacteria, pathogen, and/or similar or likewise and releases Amizade and the Releasees from any damage, injury, loss, and/or death to the participant that may result from any such illness, virus, bacteria, pathogen, ailments, or similar/likewise. Additionally, Amizade (or its authorized representative) reserves the right to postpone, cancel, and/or modify any travel, trip, program, and/or activity because of these aforementioned issues/conditions.
Waiver and Release
In consideration of my participation in the Amizade program, I (being 18 years of age or older) do hereby forever release, waive, discharge, covenant not to sue, and hold harmless Amizade and my home institution, and each and every one of their past, current and future officers, directors, employees, members, volunteers, contractors, representatives, parents, owners, affiliates, agents, successors and assigns (the “Amizade Releasees”), from any and all damages, injuries, losses, liability, claims, causes of action, litigation or demands, including, but not limited to, those for personal injury, illness, death, property damages, expenses or other consequences resulting directly or indirectly from or in any manner arising out of, related to, or in connection with COVID-19 and in connection with my participation in an Amizade program or any travel related thereto. I further covenant not to sue Amizade and/or the home institution in connection with any of the claims released herein.
I am aware that during my participation in an Amizade program, certain risks and dangers may arise, including, but not limited to: the hazards of traveling in mountainous terrain, high altitudes, or undeveloped areas; travel by raft, canoe, boat, bicycle, train, plane, automobile, horseback, or similar and/or by other means of conveyance, or on foot; roads, trails, hotels, vehicles, boats or other means of conveyance which are not operated nor maintained to standards common in the United States; the forces of nature including injury and/or death from animals; civil unrest; weather or natural disasters, political demonstrations, terrorism; accident or illness without access to means of evacuation or availability of medical supplies; physical exertion for which I am unprepared; consumption of alcoholic beverages; the negligence (but not willful or fraudulent conduct) on the part of Amizade, Ltd. or others; or factors known or unknown. I am also aware that medical services or facilities may not be readily available or accessible during some or all of the time that I am participating in the trip. Amizade shall have no liability regarding the adequacy of any medical care, equipment or supplies that may be provided in conjunction with their programs.
This Agreement (and the waiver and release set forth herein) shall also be binding on my heirs, executors, administrators, assigns, successors, and all other persons who may claim through me. I expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by applicable laws, and that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. This Agreement contains the entire understanding of the parties relating to the subject matter, and shall not be altered, modified, amended, waived or supplemented in any manner whatsoever except by a written agreement signed by both parties hereto or their duly authorized representatives. This Agreement may be executed, made and delivered electronically.
To the maximum extent permitted by applicable law, I (a) covenant and agree not to elect a trial by jury with respect to any issue arising out of or relating to this Agreement that is triable of right by a jury, and (b) waive any right to trial by jury with respect to such issue to the extent that any such right exists now or in the future. This waiver of right to trial by jury is given knowingly and voluntarily. Any dispute arising from this agreement and/or related travel or activities shall be resolved in the Commonwealth of Pennsylvania and subject to Pennsylvania law.
I have carefully read this Assumption of Risk, Waiver, and Release before agreeing to it and enter into it voluntarily in consideration of the opportunity to participate in the Amizade program. I acknowledge that I am giving up legal rights and/or remedies which may be available to me.
For the above Intentions and Actions: * Signature *
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Name of Parent or Legal Guardian of Applicant: * Signature of Parent or Legal Guardian of Applicant: *
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Appendix A: Amizade Health & Safety Policy
During travel, as in other settings, participants can have a major impact on their own health and safety through the decisions they make before and during their program and by their day-to-day choices and behaviors.
Assume responsibility for all the elements necessary for their personal preparation for the program and participate fully in orientations.
Read and carefully consider all materials issued by Amizade and the home institution that relate to safety, health, legal, environmental, political, cultural, and religious conditions in the host country(ies).
Conduct their own research on the country(ies) they plan to visit with particular emphasis on health and safety concerns, as well as the social, cultural, and political situations.
Consider their physical and mental health, and other personal circumstances when applying for or accepting a place in a program, and make available to Amizade and the home institution accurate and complete physical and mental health information and any other personal data that is necessary in planning for a safe and healthy travel experience.
Maintain appropriate insurance coverage and abide by any conditions imposed by the carriers.
Inform parents/guardians/families and any others who may need to know about their participation in the study abroad program, provide them with emergency contact information, and keep them informed of their whereabouts and activities.
Understand and comply with the terms of participation, codes of conduct, and emergency procedures of the program.
Attend ALL pre-departure and on-site orientations.
Be aware of local conditions and customs that may present health or safety risks when making daily choices and decisions. Promptly express any health or safety concerns to Amizade staff, site directors, and the home institution before and/or during the program.
Sign up to receive embassy and travel alerts for their host country and countries to which they may travel.
Accept responsibility for their own decisions and actions.
Obey host-country laws and comply with authorities in the event of an emergency or crisis.
Behave in a manner that is respectful of the rights and well-being of others, and encourage others to behave in a similar manner.
Avoid illegal drugs and excessive or irresponsible consumption of alcohol.
Refrain from riding in any open air vehicles, including but not limited to truck beds, motorcycles, scooters, mopeds, and personal watercraft.
Become familiar with the procedures for obtaining emergency health and legal system services in the host county.
Appendix B: Group Conduct Agreement
Your upcoming experience will be successful only when all participants treat each other with respect, cooperate with each other, and live up to the highest standards of conduct. The following pledge is to remind you of your responsibilities to the community and the successful outcomes of the trip. All Amizade participants are expected to abide by all applicable laws, rules, and guidelines related to any program travel and to which the participant may be subject to per applicable travel locations related to Amizade’s program and corresponding activities. Each participant should be aware that laws of other countries, including countries of host/program locations, may have laws that differ from the United States and that these laws can have different (and often very severe) penalties and/or consequences for violations (e.g., firearms, drugs, sexual behavior, damage to property, etc.).
Each participant is expected to hold themself to the highest standard while participating in any aspect of an Amizade program and while traveling. Accordingly, Amizade (and/or its authorized representative) reserves the right to dismiss any participant from a travel program and/or location/site (at any point and at the participant’s own cost) for failure to abide by applicable rules or laws.
Intentions and Acknowledgements for Each Participant:
My language, actions, and behavior will present a positive image to others of my city, my country, and myself.
I will respect and cooperate with those around me, including fellow participants, trip leaders, chaperones, guides, host families, community members, and anyone I interact with during the trip.
I will listen to instructions and follow them accordingly.
I will not behave in a way that is unsafe, is a bad influence on others, or which makes life difficult for others.
I will prioritize my health and the health of others, even when it feels annoying, cumbersome or inconvenient.
I will not break any local or US laws or other applicable laws, including the use of any illegal drugs or other controlled substances. I understand that certain drugs and/or other controlled substances and/or similar substances may be regulated differently in applicable countries.
I understand that stealing is not tolerated.
I will not carry or use dangerous items such as large knives, firecrackers, explosives, firearms, etc.
I will follow all safety rules. I understand that safety rules are necessary to do the things we do safely, and that chaperones cannot take responsibility for my safety when I do not cooperate. I realize that breaking safety rules can endanger others as well as myself.
I will follow Amizade's "no open air vehicle policy" which includes policies prohibiting participants from riding in the back of a truck, on a motorcycle, or on a personal watercraft (including jet ski, wave runner, and/or similar). There are no exceptions to this rule.
I will abide by all water safety instructions as directed by the Amizade site director and Amizade staff.
I will not engage in any unauthorized travel.
I will not bully, threaten, harass, and/or otherwise act inappropriately towards other program participants, Amizade personnel (including employees, site directors or their staff, representatives and/or similar) as well as members of the community, host family members, chaperones, guides, trip leaders, and anyone else I interact with on the trip.
I will follow all COVID-19 related safety procedures and I will prioritize the health and safety of myself, my fellow travelers and my host community by wearing a mask, social distancing, sanitizing my hands and following any and all additional safety protocols.
I will act in an appropriate and respectful manner towards the local people in accordance with the customs, laws, regulations, and ordinances of the host country(ies).
I will be ecologically aware and conduct myself in a manner that lessens my impact on the natural environments through which I travel.
Appendix C: Withdrawal and Cancellation Policy
Student Withdrawal: If written notice of a withdrawal is submitted more than 45 days prior to the program start date, a full refund will be granted. If a participant withdraws 45 - 30 days in advance to the program, Amizade will refund 50% of the individual’s program fee. If there is a participant withdrawal under 30 days prior to departure, Amizade will use its discretion (in partnership with the local communities) on possible refunds. Amizade cannot guarantee any refund under 30 days prior to departure. Please note that all refunds will be issued directly to the paying party, which in most cases is the participant’s home institution.
Program Cancellation by Amizade: Amizade will cancel a program guided by the Amizade Guidelines for Site Travel rubric, which can be found on the Amizade website under the Resources tab. If Amizade cancels a program before the program start date, we will issue a full refund for the program fee and the deposit. Your group will be notified immediately by email of any program cancellation, and Amizade will advise your group on alternative options, such as switching to a different program location, or deferring participation to a future date, or converting the programs into a virtual service learning program. In the unlikely scenario that Amizade cancels a program on or after the program start date, we will issue a refund for recoverable expenses and assist and support your group in navigating next steps necessitated by program cancellation. However, we cannot guarantee that expenses will be recoverable, and any deposits are non-refundable. For more information on approach to health and safety, please refer to the COVID-19 Resources tab on our website.