COVID-19 Acknowledgement and Release Agreement for WPI-Sponsored Travel

The purpose of this COVID-19 Acknowledgement and Release Agreement (the “Agreement”) is to make sure that, with respect to the WPI-Sponsored Travel identified herein (1) I understand, acknowledge, and consent to the travel risks, (2) I am freely and voluntarily participating despite these risks, and (3) I release WPI from any and all liabilities associated with my travel.

I hereby understand, acknowledge, agree to, and/or consent to the following, as a condition to my participation in the WPI-Sponsored Travel: 

  1. The novel coronavirus, COVID-19, is a highly infectious, life-threatening disease declared by the World Health Organization to be a global pandemic. There is no current vaccine for COVID-19. COVID-19’s highly contagious nature means that contact with others, or contact with surfaces that have been exposed to the virus, may lead to infection, which may result in personal injury, illness, permanent disability, and/or even death. Because of its highly contagious and sometimes “hidden” nature, it is currently very difficult to control the spread of COVID-19 or to determine whether, where, or how a specific individual may have been exposed to the disease. I understand and acknowledge that given the unknown nature of COVID-19, it is not possible to list each and every individual risk of contracting COVID-19.
  1. Travel increases my chances of getting and spreading COVID-19 and the Centers for Disease Control and Prevention (CDC) and the Commonwealth of Massachusetts recommend that travelers avoid all nonessential travel. I have reviewed the CDC and Massachusetts information on COVID-19 for travelers, including Massachusetts’ COVID-19 orders and guidance related to travel.
  1. I received the approval(s) required by WPI to participate in this WPI-Sponsored Travel as identified below. If I am a student participating in WPI-Sponsored Travel to an international destination(s), I have received the approval of the Global Travel Review and Response Team (GTRRT) and I will comply with the restrictions the GTRRT has placed on my travel.  I have registered my WPI-Sponsored Travel on the WPI MyTrips Travel Registry if my travel involves at least one (1) overnight.
  1. I will read and comply with all applicable health guidance, protocols, and requirements related to COVID-19 while participating in WPI-Sponsored Travel, including, but not limited to, Massachusetts’ COVID-19 orders and guidance related to travel, the guidance on the WeAreWPI website, and the requirements of my destination(s). If I am a student, I agree that I will comply with the WPI Code of Conduct and COVID addendum.
  1. Medical/health care resources and facilities may be limited or non-existent at my destination(s). I acknowledge that I have appropriate master medical insurance for injuries or illnesses and that I am solely responsible for any co-pay, deductible, or other fees or expenses associated with medical services that may be provided to me during my WPI-Sponsored Travel. I authorize WPI to act on my behalf in any medical emergency, if applicable.
  1. My destination(s), Massachusetts, the United States, and any states or countries I may travel through at any point during my WPI-Sponsored Travel may enact restrictions, including entry bans, lockdowns, and/or quarantines, at any time, and these restrictions have the potential to disrupt my WPI-Sponsored Travel. I agree that I am responsible for any costs associated with such restrictions, including entry bans, lockdowns, and/or quarantines, during my WPI-Sponsored Travel or upon my return to Massachusetts.
  1. WPI reserves the right to modify or cancel my WPI-Sponsored Travel at any time for health, safety, or security reasons and I will comply with any directives from WPI to modify or cancel my WPI-Sponsored Travel and immediately return to or remain in Massachusetts.                            
  2. Upon return to Massachusetts, I will comply with Massachusetts’ COVID-19 orders and guidance related to travel, including any requirements to complete travel forms, COVID-19 testing, and/or quarantine as applicable. I agree that I will not come to campus if I have a fever or other COVID-19-like symptoms; if I am advised to self-isolate or get tested for COVID-19; if I test positive for COVID-19; or if I have been in close contact with someone, including any member of my household, who I know has tested positive for COVID-19, is being tested for COVID-19, or has COVID-19-like symptoms. For purposes of contact tracing, I will immediately report any positive COVID-19 test, for myself or close contact, to WPI on this form.

  3. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF ILLNESS OR INJURY that may be sustained by me due to any potential exposure to COVID-19 while participating in WPI-Sponsored Travel. I hereby RELEASE WAIVE, DISCHARGE, AND COVENANT NOT TO SUE WPI, its affiliates, subsidiaries, trustees, officers, students, employees and agents, and their respective successors, heirs, and assigns (the “Related Parties”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out or related to any illness or injury, that may be sustained by me due to any potential exposure to COVID-19 while participating in WPI-Sponsored Travel, whether caused by the negligent act or omission of WPI, or otherwise, while participating in WPI-Sponsored Travel.  It is my express intent that this Agreement shall bind the members of my family, my heirs, assigns and personal representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, and COVENANT NOT TO SUE WPI and the Related Parties.

Traveler Type *
Destination(s) of WPI Sponsored Travel:
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Traveler's Signature *
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Is the traveler under 18 years old? *
Parent/Guardian Signature: *
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