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Please read these instructions carefully before using the waiver forms provided on this site. These Instructions will help you determine which waiver is appropriate to your activity, event, or trip (the “Experience”).

Click this link to access the Waiver Form Matrix. The Waiver Form Matrix contains a link to access a PDF form for each of the various waivers and forms.

The information contained in these Instructions is provided to assist you step-by-step with:

  • Determining whether you/your group needs a waiver(s) for your Experience;

  • Helping you select the proper form(s), if your Experience needs a waiver(s);

  • Explaining how to prepare and use the forms that you need; and

  • Retention of forms.

Importantly, the information and documents provided here do not grant permission for you to engage in or participate in a particular Experience. Permission to engage in or participate in a particular Experience must come from the appropriate University department or office before you may use these forms.

If you have any questions after reviewing all of the information provided on this page, please contact Mary Beth Townsley at (513) 745-2090 or by email at townsley@xavier.edu as soon as possible (before your waivers are needed so that she may have ample time to provide assistance). If Mary Beth is unavailable and your activity is about to begin, err on the side of caution and use the form that you reasonably believe is most appropriate for your Experience.

The forms provided here are the only forms approved by Xavier University and may not be modified, re-typed, or changed in any way without specific approval from the Risk Management & Insurance office or from General Counsel. If an outside organization has supplied an alternate form for your Experience, then you must consult with Mary Beth Townsley.

 

WHAT IS A 'WAIVER"?

 

As the terms are used by Xavier University, “waiver” refers to the various documents titled “Assumption of Risk and Release Agreement” and “Health History Form.” Xavier students, Xavier faculty members and employees, as well as non-Xavier individuals (alumni, parents of Xavier students, volunteers, coaches who are not employees, visitors, etc.) may need to sign one or more of these waiver forms before participating in certain on- and off-campus Experiences.

 

IS A WAIVER REQUIRED FOR MY SPECIFIC ACTIVITY OR GROUP?

 

International Travel Experiences: Waivers are always required for Xavier University-sponsored or affiliated international travel, regardless of the length of the Experience.

 

Off-Campus Experiences – Five or More Overnights: Waivers are always required for Xavier University-sponsored or affiliated off-campus Experiences where the Experience is expected to consist of five or more off-campus overnight stays.  

 

Off-Campus Experiences – Zero to Four Overnights: If a Xavier University-sponsored or affiliated off-campus Experience is expected to consist of four or fewer overnight stays (including no overnight stay), then a waiver is only required if the Experience is expected to involve unusual risks or the Experience tends to be more risky than everyday on-campus events or activities.  (Click here for help making this determination.)

 

On-Campus Experiences: Waivers are only required if the on-campus Experience is expected to involve unusual risks or the Experience tends to be more risky than everyday on-campus events or activities.  (Click here for help making this determination.)

 

WHICH FORM SHOULD I USE?

 

Once you have determined that your Experience requires a waiver, the Waiver Form Matrix will direct you to the appropriate form(s) based on 1) the individuals participating in the Experience, and 2) the type of Experience.  See the descriptions below to help understand the headings used in the Waiver Form Matrix and select the appropriate form(s).  Click on the link(s) provided in the Waiver Form Matrix to open the required form(s).  Each participant must print and execute all pages contained in the link of the required form(s).

 

Type of Participant:    Which waiver is needed depends on whether the participants are Xavier students, faculty members, or employees (“Xavier Individual”) or whether the participants are Non-Xavier individuals. If the participants fall under more than one category, forms are needed for each category represented in the group of participants.

 

Xavier Individuals (Xavier Students and Xavier Faculty Members or Employees):

 

  • Xavier Students: A student becomes a Xavier student on the date that he/she certifies that he/she has health insurance. For students who first take classes at Xavier University in a Fall Semester, this is typically around August 15.

 

  • Xavier Faculty Members or Employees: An individual is deemed a Xavier faculty member or a Xavier employee if the individual receives a W2 from Xavier University for tax purposes.

 

Generally, faculty members and employees participate in an Experience as part of their employment and as representatives of Xavier University, even if the Experience is unrelated to the faculty member or employee’s role at Xavier. When a faculty member or employee is acting within the scope of his or her employment, he or she is not required to sign an Assumption of Risk and Release Agreement. However, a Health History Form must be signed by faculty or employees if it is required for that type of Experience.

 

For example, an employee who is asked to go on an Alternative Break trip with students is considered to be acting within the scope of his or her employment because there is a Xavier University purpose for that employee’s participation (i.e., to act as a Xavier representative on that trip).  An Assumption of Risk and Release Agreement is not required.  A Health History Form may be required.

 

In the alternative, if a Xavier faculty member or employee is not acting within the scope of his or her employment, then he or she must sign the Assumption of Risk and Release Agreement form relating to the particular Experience.

 

For example, if an employee decides he or she would like to go on an Alternative Break trip, but the University already has sufficient representatives going, and his or her participation would thus be for purely personal reasons, then he or she must sign the appropriate Assumption of Risk and Release Agreement form and the Health History Form if required.

 

Non-Xavier Individuals: “Non-Xavier individuals” includes but is not limited to (1) students, faculty, and employees from other schools, (2) partners, family members, and friends of Xavier individuals, (3) guest ministers; (4) volunteers, including some coaches for NCAA and/or club sports; (5) coaches who are independent contractors; and (6) all other individuals who are not students, faculty members, or employees of Xavier University.

 

Independent contractors are deemed “Non-Xavier individuals.” An individual is an independent contractor, rather than a faculty member or employee, if the individual receives a 1099 for tax purposes.

 

Type of Experience: Please consider the following to help determine which forms are appropriate for your situation.

 

On-Going Experience (AOR 101): An Experience is considered ongoing if the Experience is repeated throughout the academic year or when different types of Experiences are conducted by a particular group. Form AOR 101 should be used by clubs, club sports teams, intramural sports teams, O’Connor Sports Center Fitness classes, groups, and academic classes whose members plan to or may participate in multiple Experiences of the same or similar nature with that particular group throughout an academic year.

 

For example, if a student activity club expects to have multiple activities throughout the academic year that will require a release agreement, the members of that group can, at any time, complete the appropriate form, which will then apply to all activities from that point forward.  The form will thus apply to all activities in which the student participates with that student activity club for the remainder of the academic year.

NOTE – This form will not apply to trips that are expected to include five or more overnight, off-campus stays. An Overnight Experience form (AOR 103) will need to be completed, even if the students have already executed the On-Going Experience form.

 

A faculty member or employee may execute a release agreement to cover any on- or off-campus Experience that he or she may participate in throughout an academic year, regardless of whether the Experiences are associated with different groups of students.

 

Overnight Experience (AOR 102): Use the Overnight Experience form is required for all international trips, for domestic trips that involve staying off-campus for five or more overnight stays, and for shorter domestic overnight trips that involve unusual risks or are more risky than everyday on-campus activity.

 

Overnight Experience with Travel Warning (AOR 102TW): Destinations under a U.S. State Dept. Travel Warning require prior approval and use of the specific Travel Warning waiver form. Use the Overnight Experience with Travel Warning form if you will be taking a trip that involves staying off-campus overnight and a travel warning has been issued for the specific location. If you are planning on participating in an international trip to a location with a travel warning, to obtain AOR102TW you must contact Mary Beth Townsley.

 

Day Trip Experience (AOR 103): If your Day Trip Experience includes activities that involve unusual risks or are more risky than everyday on-campus activity then use the Day Trip Experience form if your Experience does not require you to stay overnight away from campus or if the duration of the experience is less than 24 hours (even if the Experience involves an overnight stay). For example, use the Day Trip Experience form if you are participating in overnight skiing and vans transporting the participants will be leaving from campus in the evening and returning the participants the next morning.

 

On-Campus Experience (AOR 104): Because activities occur on campus daily, the On-Campus Experience form is to be used only for activities that involve unusual risks or are more risky than everyday on-campus activity. (Click here for help making this determination.)

 

Student Internship (AOR 105): Students must sign this form for all off-campus internships or co-op Experiences.

 

Student Professional Field Experience (AOR 106): Students must sign this form for those professional services disciplines requiring a field experience.  A list of courses is attached to the waiver.

 

Non-Xavier Individuals – 18 and Over (AOR 107): This form should be used if one or more participants in an Experience requiring use of waivers is a non-Xavier individual 18 years or older.

 

Non-Xavier Individuals - Under 18 (AOR 108): This form should be used if one or more participants in an Experience requiring use of waivers is a non-Xavier individual and is under 18 years old. 

 

Travel To or From Xavier University (AOR 109): This waiver should be signed by individuals boarding Xavier-sponsored or –affiliated transportation when no other waiver has been required.

 

Separation from Group Travel (AOR 110): This waiver should be used when an individual is separating from the Xavier-sponsored or –affiliated travel Experience. 

 

O’Connor Sports Center (Non-Xavier Students) (AOR 111): Available at the O’Connor Sports Center.  This form should be used by individuals who will be using the O’Connor Sports Center but who are not Xavier students.  Xavier faculty and employees may use this form.

 

Heath History Forms:

Please consider the following to help determine whether any of the following health related forms are necessary for your Experience.

 

Student Health History Form Domestic and International (HHF 201): This form should be used by Xavier students participating in an Experience that involves any overnight travel.

 

Student Health Screening Exam Form (HHF 202): This form should be used by Xavier students participating in an Experience that involves any international travel.

 

Faculty/Employee Health History Form Domestic and International (HHF 203): This form should be used by Xavier faculty members and employees participating in an Experience that involves any overnight travel.

 

WHAT DO I DO ONCE I KNOW WHICH FORMS I NEED?

 

Once you determine the category that best suits the particular Experience and status of the participants, go to the Waiver Form Matrix and click on the link(s) which will open the PDF form(s) that you need.  Each participant will need to print and execute all the pages contained in the link.

 

View a PDF version of this chart

 

 

IMPORTANT INFORMATION REGARDING USE OF THESE FORMS:

 

  • Blanks on each form should be completed as indicated by each individual participating in the Experience. All blanks on the appropriate form(s) must be filled in.

 

  • Each participant (or participant’s parent/guardian, if participant is under 18) must sign and date all required form(s) prior to participating in an Experience.

 

  • The Experience organizer should ensure that each participant signs the appropriate form(s) and should collect the completed forms before starting the Experience.

 

  • If you have read the material on this page and are still unsure of whether or not you need a waiver, please contact Mary Beth Townsley.  If Mary Beth is unavailable and your activity is about to begin, please err on the side of caution and use the waiver that you believe is most appropriate for your type of activity.

 

  • The only University-approved forms are those posted to this site.  These forms are periodically updated so be sure to use the currently-posted forms.  All University-approved forms are marked as such.  If an outside organization has supplied an alternate form for your activity or group, you must consult with Mary Beth Townsley.

 

  • No one is permitted to alter the content of these forms without specific approval from Risk Management & Insurance Office.

 

  • Using documents and information provided on this site does not give you permission for your particular Experience.  That permission must come from the appropriate University department or office before you may use these forms. 

 

WHICH FORMS MUST BE NOTARIZED?

 

The notary requirement for University waivers has been eliminated; the forms no longer need to be notarized.

 

RETENTION OF FORMS:

 

  1. Keep a copy of the signed release agreement (the AOR form).

The Experience organizer, group leader, or individual traveling alone should have in his or her possession all original signed forms during the Experience.

A student traveling alone must carry the original signed forms. In a medical emergency, only the original form is acceptable; a copy may not be accepted.

 

  1. Give a copy of the signed waiver to the office or department sponsoring the Experience.

During the Experience, the sponsoring office or department should keep one paper or electronic copy of all completed, signed forms. You are encouraged to print forms using both sides of the paper (print double sided).

 

  1. Retention of signed forms.

Because an individual who is hurt while participating in an Experience will generally have only two years to bring any legal claims, one paper or electronic copy of all forms executed should be retained by the office or department sponsoring the Experience for a period of two years after the Experience is over. The stored copy of the signed completed forms may be a scanned electronic copy, a paper copy, or the original signed forms.    

 

  1. Give a copy of the signed waiver to Campus Police (XUPD) along with an itinerary if applicable to your Experience. 

Campus Police should be given one paper or electronic copy of the signed forms before the Experience begins if the Experience is off-campus.  Campus Police will discard their copy after the Experience concludes.