forms

Health, Behavior and Liability Waiver

Please, complete the form below:

PERSONAL INFORMATION

Note: If attending multiple semesters/sessions at SRISA, select the first one you will be here for.

HEALTH INFORMATION

The following information is requested in order for SRISA to better provide assistance and services catered to your personal needs when on campus. Please select the answer that best describes the items below in relation to you:

* General health concerns (Eating and sleeping habits, weight, mobility, etc.)

* Specific illness or social/emotional or behavioral issues

* Allergies (food, insects, medication, etc.)

* Prescription medication (daily or occasionally use)

* Problems with vision, hearing, or speech (glasses, contacts, hearing aids)

* Significant recent injury or accident

* Other

AGREEMENT FOR PARTICIPATION

I, a student at Santa Reparata International School of Art (herein after “SRISA”), hereby agree as follows:

  1. I will comply with SRISA’s student conduct regulations throughout the duration of my participation in the program. I agree that the SRISA Director has the right to enforce appropriate standards of behavior and that I may be dismissed from SRISA at any time for failure to comply with such standards.
  2. I understand that while I am in a foreign country, I will be subject to the laws of that country. I agree to comply with those laws, as well as with the regulations of SRISA, including refraining from using, possessing or selling any illegal drugs. I understand that being charged with any infraction of the laws of the host country, including possession of any illegal drugs is grounds for immediate expulsion from SRISA, without refund.
  3. I understand and acknowledge that there is inherent health risks associated with traveling abroad and that I am required to have an insurance policy that covers medical services and treatment during the period of study at SRISA. I agree that I am personally responsible for obtaining all health information, instruction, medical procedures, immunizations, and medications appropriate to my travel. I further agree that if I become incapacitated, SRISA, through its agents and employees, may take whatever action is deemed necessary with respect to my health and safety, and I release them from any liability for such actions. I authorize SRISA, its agents and employees, at their discretion, to place me for medical treatment at my expense.
  4. SRISA strongly discourages students from operating vehicles while participating in its programs, due to the inherent dangers of driving in a country with different traffic laws and regulations, driving habits, and regulations relating to insurance. If, however, I decide to operate a motor vehicle, SRISA assumes no financial responsibility for legal aid or for my care if I am involved in a violation or an accident.
  5. I understand that SRISA is not responsible for any injury or loss I may suffer when I am traveling independently or am otherwise separated or absent from any SRISA supervised activities.
  6. I understand that I will have the opportunity to participate in SRISA sponsored field trips and activities while in the program and that all school rules and regulations apply. I will abide by the standards established for proper conduct and follow the instructions of SRISA staff members and its agents.
  7. I understand that I am responsible for my welfare while abroad. I authorize SRISA, its agents and employees, to contact my parent or guardian, or designated contact person, as indicated in my Emergency Contact Information, in connection with my general welfare abroad.

AGREEMENT AND RELEASE FORM

I understand that, although SRISA has made reasonable efforts to provide for my safety while participating in its programs and activities, there are unavoidable risks in foreign travel, and I may subject myself to dangers over which neither SRISA, its agents, nor its employees have any control. These dangers might include, but are not limited to, airline and motor vehicle accidents, criminal behavior or negligence by others, health problems, theft, etc. I hereby acknowledge that I have applied and choose to participate in SRISA and voluntarily engage in field trips and activities of the programs conducted by SRISA. I hereby acknowledge my awareness that my participation in SRISA and its programs may involve the risk of injury to my person and property. These may include, but are not limited to the following: bodily injury, death, property damage, etc. I voluntarily accept all risks of property damage and bodily or personal injury arising as a result of participation in SRISA or travel in the host country or region. Being fully aware of the possible risks and consequences of my voluntary participation in SRISA, I hereby agree to forever hold harmless SRISA and each of its officers, Board of Directors, the members individually, agents, and employees. I further covenant and agree I will not sue SRISA and each of its officers, Board of Directors, the members individually, agents, and employees. This agreement and release shall also be binding on my heirs, assignees, successors, and all other persons who may claim through me.

BEHAVIOR CONTRACT

As a student attending courses at Santa Reparata International School of Art (SRISA), either directly enrolled or through a visiting program, I understand that I am required to respect the rules and regulations established by SRISA.

I understand that my enrollment in SRISA courses and participation in SRISA housing is contingent on my respecting the rules and regulations as outlined below.

I understand that I…

  • Must obey Italian Law and that violation of these laws may result in being expelled from the program.
  • May not abuse or consume excessive amounts of alcohol for the purpose of becoming intoxicated. Upon violation I will be asked to leave the program and SRISA housing at my own expense.
  • May not use illegal drugs during the permanence of the SRISA program. Use of drugs while on the program and in SRISA housing can result in being expelled from the program and SRISA housing without any refunds. I understand that, while legal in several US States, marijuana is illegal in Italy in all manner of consumption (medicinal and recreational).
  • May not use or bring illegal drugs on campus.
  • Must be respectful of all students, faculty and staff members at SRISA. I understand that SRISA is an all-inclusive environment that embraces diversity.
  • Must not engage in aggressive and harassing behavior, neither physical, verbal, nor cyber, while on the program.
  • Must not conduct myself in such a manner that puts my peers, professors, and/or SRISA staff in harm in any way.
  • Must treat the facilities, materials and equipment with care, making sure to use any equipment and supplies properly, communicating with SRISA staff when equipment is not working properly and returning equipment and supplies to their proper place after use.
  • When traveling as part of a field trip, I must remain in contact with group leaders and not leave or distance myself from the group without first informing group leaders.

I understand that SRISA has an open door policy and staff is available to discuss and advise on any challenges that may arise in adjusting to my new environment.

HOUSING BEHAVIOR CONTRACT (applies to those in SRISA housing):

I understand that I…

  • Must be respectful of all those living in the apartment and building.
  • May not make noise or talk loudly on the stairs or before entrance to apartment.
  • May not make noise after 10:30 pm.
  • May not have over-night guests.
  • Must actively participate in keeping the apartment clean and free of trash.
  • Must report any damages or maintenance requests to the SRISA housing coordinator for repairs
  • May seek advice and mediation from SRISA staff should challenges arise in my apartment or between roommates.

Photograph and Imagery Release Form:

I give SRISA permission to use my name, image, voice, and/or appearance as such may be embodied in any pictures, photos, videos, digital images, and the like taken or made on behalf of SRISA. I agree that SRISA has ownership of such pictures, etc, and may use them for any purpose consistent with SRISA's mission. These uses include, but are not limited to SRISA marketing materials, social media, website, brochures, and any promotional or educational materials. I hereby release SRISA and its agents from any and all claims which may arise out of or are in any way connected with such use. I understand that should I wish to rescind permission to such use I must provide an official request to info@srisa.org stating my desire for such pictures, etc. not to be used.

COVID-19 WAIVER AND RELEASE FORM

I will read the rules and regulations regarding Covid-19 when provided by SRISA and adhere to the guidelines set in place. I understand that as a member of the SRISA community, following the rules on campus and practicing safety outside of SRISA is important for the health and safety of all those that study and work at SRISA. It is understood that I will comply with all SRISA and Italian Laws as they are in place at this moment and as they evolve.

Furthermore, I acknowledge that I freely chose to study abroad and in doing so that I am fully and personally responsible for my own safety and actions during my study abroad with SRISA. I recognize that I may be at risk of unintentional exposure due to Covid-19 at any point while abroad and any financial responsibilities that may ensue. I hereby release, waive, and discharge SRISA of any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained from or related to Covid-19.