CISV

USA

9200 Montgomery Road
Main Building 2nd Floor
Cincinnati OH
45242

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Submitted By laura.ripberger on Wed, 06/22/2016 - 11:04 am
This form is to be completed and signed by both the participant and the parent/legal guardian of any Junior Counselor, or Seminar Camperwho will travel independently either before or after his/her CISV program.

CISV International Universal Travel and Medical Insurance (“CISV Insurance”) covers every participant for the duration of the program.  

By completing this release I confirm that I have read and understand CISV International’s Programme Basic Rules (C-03) for my/my child’s program.  I further understand that CISV Insurance is limited to additional travel that conforms with those rules for my/my child’s program.   I acknowledge that my/my child's current itinerary includes independent travel before and/or after my/my child's CISV program. 

Accordingly, I hereby assume full responsibility for any and all travel, medical, or other expenses, claims or losses, including the risk of bodily injury, death or property damage that may occur as a result of any travel in violation of CISV International’s Programme Basic Rules, and/or that fall outside the CISV Insurance coverage period.

Further, I hereby waive and release any claim against or liability of the CISV Chapter named below, CISV USA, or CISV International Ltd., or any employee, officer, or volunteer of any of them, for any such claim or liability that arises due to travel outside the program dates, other than a claim that is covered by CISV Insurance.  I understand and acknowledge that I am solely responsible for arranging suitable insurance coverage for myself/my child for any travel days that fall outside the CISV Insurance coverage period.
Name of Participant's Chapter
e.g. V-17-010, S-17-019, Y-17-032, etc.
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