Skip to content

Parent/ Guardian Agreement Form

 
Student Name:  _______________________________________________________________________________________
Student ID:        _______________________________________________________________________________________
Off-Campus Program:      ______________________________________________________________________________
Off-Campus Semester:    ______________________________________________________________________________


As the parent(s)/ guardian(s) of the above student, I/ we give permission for the student to join the above program in the semester listed. 
 
I/ we jointly and separately understand and agree that in consideration of participation in said program, Albion College and/or its personnel shall assume no responsibility for any damages, expenses or liability arising from any illness or injury suffered by the student while enrolled in said program.  Note:  while off-campus at a program abroad, students will be insured by Albion College’s current international medical accident and hospitalization insurance which includes coverage for medical evacuation and repatriation. 
 
I/ we further covenant and agree that I/ we shall, and do hereby, accept full responsibility for any and all medical and/or hospitalization expenses which shall exceed the limits of the aforementioned insurance policy, or which, for whatever reasons, are not covered thereby, and shall hold Albion College and its personnel harmless from such costs and expenses.
 
I/ we also acknowledge that withdrawal from a program prior to its formal completion in no way reduces the cost or relieves the participant of paying the full charges for the program. In addition, no academic credit for the time off-campus program can be awarded to students who fail to complete the program.
 
I/ we hereby acknowledge that I/ we have read and fully understand the above Agreement, and agree to comply fully with the terms and conditions contained therein.
 

Parent/Guardian 1:
Printed Name:                                ____________________________________________     

Relationship to Student:                 ____________________________________________     

Signature:                                       ____________________________________________   

Date:                                               ____________________________________________   

Parent/Guardian 2, required if applicable:
Printed Name:                                ____________________________________________      

Relationship to Student:                 ____________________________________________     

Signature:                                       ____________________________________________   

Date:                                               ____________________________________________