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Exception Petition Travel Waiver Agreement for Parents/Legal Guardians/Next of Kin Standalone

Please enter your student’s travel information below:

Traveler Name:
Current Cellphone Phone:

Program Information

Program Start Date:
Program End Date:
Date of Arrival in Country:
Host Institution Name or Co-op Employer Name:
List Destinations (max 3):

Additional Comments (Optional):

In connection with my student’s travel for the Program and to the Travel Locations referenced above, and any other related travel, including, without limitation, personal travel for the purpose of education, personal business, social service or other experience:

I acknowledge that my student is voluntarily participating in the travel described above and is not required to travel to their Travel Location(s).
I have carefully identified, reviewed and considered the risks of travel to my Student’s Travel Location(s), including reading the most recent relevant U.S. Department of State (“DoS”) Travel Warning(s) (http://travel.state.gov), any applicable U.S. Centers for Disease Control and Prevention Travel Notice Level Three: Avoid Nonessential Travel (a “CDC Level 3”) (http://wwwnc.cdc.gov/), the most recent relevant International Security Alerts and Security Reports from the univeristy’s international response provider (found using the “My Travel Plans” link on the myNortheastern Portal).,and the latest travel advisories from the World Health Organization (http://www.who.int/ith/en/).
I acknowledge that my student’s participation in this travel may expose them to significant risks, including but not limited to terrorism, war, disease, serious bodily injury or death, property damage, and other risks that may not be foreseeable. I acknowledge that the U.S. State Department has issued a Travel Warning and/or the U.S. Centers for Disease Control and Prevention has issued a Travel Notice Level Three: Avoid Non-essential Travel for the above Travel Location(s) and/or the university’s international response provider rates the risks of travel to the Travel Location as HIGH or SEVERE and/or a travel advisory has been issued by the World Health Organization. I understand that Northeastern University (“Northeastern”) is not responsible for their safety, the University may be limited in its ability to provide assistance and resources in the event of a crisis and I assume full responsibility for all risks associated with their travel.
I understand it is my responsibility to review the health risks associated with my Student’s Travel Location(s) through the CDC Travelers Health resource, available at http://wwwnc.cdc.gov/travel/destinations/list.htm, and to discuss required or recommended vaccinations with a travel health professional, if applicable.
I freely accept all the risks associated with my Student’s travel. I expressly agree that my student is not an employee of Northeastern, and has no employee rights or benefits including, without limitation, any workers’ compensation benefits. I acknowledge that it is my responsibility to ensure that my Student has adequate medical, personal health and accident insurance coverage, as well as any insurance protection for their personal possessions.
I acknowledge that it is my student’s responsibility to abide by all applicable Northeastern policies, the laws of the host country and any country to which my student travels, and the rules/regulations of the host company/organization, and to comply with those and all travel requirements set forth by Northeastern University, GSSAC and/or the trip leader/sponsor, program director or coordinator on site. I further acknowledge that my student is required to adhere to all applicable Northeastern University rules and regulations, including but not limited to those in the applicable Northeastern University student handbook. I understand that if my student fails to comply with any such requirements they may be dismissed from the program and that dismissal from the program for a violation of any applicable rules, including this Agreement, may result in my student not receiving academic credit or a refund of tuition or any other fees or expenses paid for the program and that my student may incur additional personal and/or travel expenses, and may face additional sanctions upon return to Northeastern up to and including expulsion from the university, and withdrawal of funding or financial aid for expenses in connection with the program.
I understand that conditions in my student’s travel location(s) may change rapidly and that my student is required to stay informed of current events by obtaining updated security and health information from and enrolling in, the U.S. State Department’s Smart Traveler Enrollment Program (STEP) at https://step.state.gov/step, which also accepts enrollment for non-U.S. citizens. I understand that non-U.S. citizens are also strongly encouraged, if possible, to register with their home country Embassy or Consulate and get updated information from the U.S. and home country Embassies or Consulates, as well as the DoS, CDC, the university’s international response provider, and WHO websites.
I understand that if conditions worsen, my student may be required to return to the U.S. before completing their program and/or travel at the sole discretion of Northeastern. I understand that in such an instance my student may not receive academic credit or a refund of tuition or any other fees paid for the program and may incur additional personal and/or travel expenses.
I hereby acknowledge that I have discussed this proposed travel with my Student who has submitted this petition.
I agree that the validity, construction, interpretation and all other matters relating to this Agreement shall be governed by and interpreted in accordance with the laws of the Commonwealth of Massachusetts, without regard to its conflict of law principles. In the event of any action or proceeding to enforce any term of this Agreement, the parties shall submit to the exclusive venue of any court located in Suffolk County, Massachusetts. I expressly agree that this Agreement, waiver, and release is intended to be as broad and inclusive as permitted under Massachusetts law and that if any portion hereof is held invalid, the balance shall continue in full legal force and effect.
WAIVER AND RELEASE OF CLAIMS. I hereby release, waive, discharge and covenant not to sue Northeastern University, its trustees, officers, agents, faculty and/or employees (hereinafter referred to as “releases”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury, including permanent injury and/or death, that may be sustained by my student in connection with travel and/or study at the travel location(s) described above. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including permanent injury and/or death that may be sustained by my student as a result of their traveling to the travel location(s) described above. I further hereby agree to defend, indemnify and save and hold harmless the releases and each of them, from any loss, liability, damage or costs they may incur as a result of my student’s travels. It is my express intent that this release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be deemed as a release, waiver, discharge and covenant not to sue the above named releasees.

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June 19, 2018 2:20 pm EDT

Exception Petition Travel Waiver Agreement for Parents/Legal Guardians/Next of Kin Standalone Uploaded by ISO on behalf of ISSAC - MYTRAVELPLANS@northeastern.edu IP 73.186.253.206