Sherbin Fellowship General Release Form – Grants, Scholarships and Fellowships

Required form for the selected Sherbin Fellow to complete

Name(Required)

First Last

Phone

Address(Required)

Enter your permanent (home) address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter the email address you will be using during your fellowship. This should not be your kzoo.edu address.

General Release Form

I, a student at Kalamazoo College (the “College”), in consideration for being selected to participate in the Jerry Sherbin Fellowship (the “Opportunity”), hereby agree to the following:

Term 1(Required)

1. I waive and release any claims or potential claims of myself, my heirs, my relatives or any other interested party, against the College and any other cooperating institution, their employees, representatives, agents, and successors, arising from my participation in the Opportunity, including, but not limited to, claims or causes of action for inconvenience, damage to or loss of property, medical or hospital care, personal illness, injury, or death, arising out of my participation in the Opportunity and/or any travel or other activity conducted by or under the control of the College or any cooperating institution.

I agree to term 1

Term 2(Required)

2. This agreement also covers any participation I may have in activities related to the Opportunity, such as volunteering at a hospital, medical facility or clinic, teaching at a school, or providing other community services. I understand that some of these activities are inherently dangerous and may bring me into contact with individuals with serious illnesses, including those with communicable diseases, mental diseases and disorders. I understand that by attending, observing or participating in any activities related to the Opportunity, I could potentially contract a serious disease or illness, or I could have a dangerous or traumatic encounter. By signing this agreement, I agree that I am assuming the risks of what may happen to me because of my participation in any activity related to the Opportunity. This includes all of the illnesses, diseases and medical conditions which I may contract during my Opportunity or during my attendance, observation or participation in any activity associated with that Opportunity.

I agree to term 2

Term 3(Required)

3. I understand that participating in the Opportunity might place me at risk. I understand that cultural, language, social and other differences make it necessary for me to exercise caution in all that I do. I accept full legal and equitable responsibility for my behavior while participating in the Opportunity and the consequences of that behavior, including, but not limited to, contracting a sexually transmitted disease, being subject to criminal or civil punishment by the government of the state/country(ies) in which I will be traveling, and violence or criminal activity of which I am the victim.

I agree to term 3

Term 4(Required)

4. I agree to indemnify the College and any cooperating institutions, their employees, representatives, agents, and successors, for all financial obligations or liabilities that I personally incur while I am participating in the Opportunity, including, but not limited to, attorneys fees and court costs resulting from my actions, errors, or omissions.

I agree to term 4

Term 5(Required)

5. I agree that I will be financially responsible for maintaining my own accident, medical, and health insurance for the duration of my enrollment in the Opportunity. I agree that I am responsible for obtaining all health information, medical procedures, immunizations, and prophylactic medications appropriate to my enrollment in the Opportunity. I agree to adhere to all necessary health and safety precautions.

I agree to term 5

Term 6(Required)

6. I understand it is my responsibility to understand and comply with any country entry requirements or local public health requirements. I understand it is my responsibility to remain informed about local public health conditions and any Covid related restrictions due to my travel. I understand that I am financially responsible for any visa fees, Covid tests, revised travel arrangements due to Covid, or other measures that may be necessary during the course of my participation the Opportunity.

I agree to term 6

Term 7(Required)

7. I understand and agree that any dispute arising from this agreement, from my participation in the Opportunity, or from my participation in activities related to the Opportunity, which arises between me, the College, any cooperating institution, and/or another student must be brought before a Michigan state or federal court sitting within Kalamazoo County, and will be governed by Michigan law.

I agree to term 7

Term 8(Required)

8. I understand and agree that if a court of law finds any provision or aspect of this agreement unenforceable, the remaining provisions will remain in full force and effect, and the court will construe the unenforceable provision to make it legally enforceable.

I agree to term 8

Term 9(Required)

9. I understand and agree that this agreement represents the complete agreement with the College concerning the matters set forth in this agreement. This agreement waives and supersedes any previous or contemporaneous understandings I may have had with the College on the matters covered by this agreement, whether written or oral. This agreement shall not be changed or amended in any way except in writing signed by the Colleges President and/or the Presidents designated representative, and myself or legal guardian.

I agree to term 9

Signature(Required)

I acknowledge, by my electronic signature, that I have fully read and understood every provision of this agreement. I also acknowledge that I am voluntarily entering into this agreement with my full and free consent. I acknowledge that I am at least eighteen years of age and am my own legal guardian, and if not, that I have secured below the signature of my parent or legal guardian as well as my own.