{"id":2615,"date":"2019-06-13T12:53:07","date_gmt":"2019-06-13T16:53:07","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/ghbusm\/?page_id=2615"},"modified":"2019-06-13T13:06:35","modified_gmt":"2019-06-13T17:06:35","slug":"acknowledgement-and-waiver-of-liability","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/ghbusm\/acknowledgement-and-waiver-of-liability\/","title":{"rendered":"Acknowledgement and Waiver of Liability"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_10' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/ghbusm\/wp-json\/wp\/v2\/pages\/2615' data-formid='10' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_10_72\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_72\"><p><font color=\"#990000\">[ If you are a B.U. medical student who will be undertaking \n  a global health, B.U.-sanctioned activity, you are required to read and sign \n  the following acknowledgement and waiver of liability before departure. Global \n  health activities include (but are not limited to): 1) clinical electives abroad \n  (4th year); or 2) summer global health experiences (between first and second \n  year). ]<\/font><\/p>\n<p>I would like to participate in the Global Health Program elective\/activity \n  indicated on this form (below). This is an optional, elective, clinical activity \n  being offered to Boston University School of Medicine students. I recognize \n  that even though I will be receiving academic credit (if my participation in \n  this elective is approved), my participation in this particular elective is \n  not mandated in order to fulfill academic requirements of the Boston University \n  School of Medicine. My participation in this elective is a voluntary decision \n  on my part. <\/p>\n<p>I acknowledge that I am aware that there are risks to me of injury entailed \n  in my participation in this elective, including the risks of travel to and from \n  the country where the elective will take place, as well as the risks associated \n  with residing in a foreign country whose level of health care and social services \n  may not equal those in the United States. These risks include, but are not limited \n  to, crime, terrorism, war, exposure to communicable diseases, serious bodily \n  injury or death, property damage and other risks that may not be foreseeable. \n  I do fully and completely assume any risks solely to myself, and accept full \n  responsibility for my individual physical fitness to participate in this elective \n  and its activities. Although Boston University will provide as much information \n  as possible on this elective and its activities, I also acknowledge that it \n  is my responsibility to review the course materials and to request further information \n  if needed to make a proper participation decision. I understand that Boston \n  University does not control or run every aspect of the elective, and the University \n  gives no assurances or warranties whatsoever as to the safety of participants \n  in this program. <\/p>\n<p><i>In consideration of being presented the opportunity to participate in this \n  Global Health Program elective, and in acknowledging that I am aware of and \n  willing to assume the risks associated with this activity, I hereby voluntarily \n  agree to waive, hold harmless and indemnify the Trustees of Boston University \n  and its trustees, agents, volunteers and employees from any and all claims, \n  demands, damages and causes of action of any nature whatsoever arising out of \n  ordinary negligence which I, my heirs, my assigns or successors may have against \n  them for, on account of, or by reason of my participation in the Global Health \n  Program elective noted below. <\/i><\/p>\n<\/li><li id=\"field_10_89\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_89\"><h2 class=\"gsection_title\">Student&#039;s Signature<\/h2><\/li><li id=\"field_10_84\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_84\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Click below to indicate that you understand the content above and you execute this GENERAL RELEASE, WAIVER OF CLAIM AND ASSUMPTION OF RISK AGREEMENT of your own free will and accord.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_84'><li class='gchoice gchoice_10_84_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.1' type='checkbox'  value='&lt;i&gt;In consideration of being presented the opportunity to participate in this    Global Health Program elective, and in acknowledging that I am aware of and    willing to assume the risks associated with this activity, I hereby voluntarily    agree to waive, hold harmless and indemnify the Trustees of Boston University    and its trustees, agents, volunteers and employees from any and all claims,    demands, damages and causes of action of any nature whatsoever arising out of    ordinary negligence which I, my heirs, my assigns or successors may have against    them for, on account of, or by reason of my participation in the Global Health    Program elective noted below. &lt;\/i&gt;'  id='choice_10_84_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_84_1' id='label_10_84_1' class='gform-field-label gform-field-label--type-inline'><i>In consideration of being presented the opportunity to participate in this    Global Health Program elective, and in acknowledging that I am aware of and    willing to assume the risks associated with this activity, I hereby voluntarily    agree to waive, hold harmless and indemnify the Trustees of Boston University    and its trustees, agents, volunteers and employees from any and all claims,    demands, damages and causes of action of any nature whatsoever arising out of    ordinary negligence which I, my heirs, my assigns or successors may have against    them for, on account of, or by reason of my participation in the Global Health    Program elective noted below. <\/i><\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_5\"  class=\"gfield gfield--type-date gfield--input-type- gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\"><label class='gfield_label gform-field-label' for='input_10_5' >Today&#039;s Date:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_5' id='input_10_5' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'    aria-describedby=\"input_10_5_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_10_5_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_10_5' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_10_81\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_81\"><h2 class=\"gsection_title\">Student Information<\/h2><\/li><li id=\"field_10_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Student Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_10_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_90\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_90\"><label class='gfield_label gform-field-label' for='input_10_90' >Class Year of Student:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_10_90' type='text' value='' class='small' maxlength='4'    aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_10_31\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_31\"><label class='gfield_label gform-field-label' for='input_10_31' >Email of Student:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_10_31' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  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  placeholder='mm\/dd\/yyyy' aria-describedby=\"input_10_44_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_10_44_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_10_44' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_10_45\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_45\"><label class='gfield_label gform-field-label' for='input_10_45' >End Date of Elective:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_10_45' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_10_45_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_10_45_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_10_45' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_10_40\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_10_40\"><label class='gfield_label gform-field-label' for='input_10_40' 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