Waiver of Liability and Release:
In consideration for being permitted to participate in this internship agreement, I fully recognize and appreciate the dangers and risks inherent in such activities, and do hereby waive, release, and forever discharge West Shore Community College, its officers, agents, and employees, as well as any participating employer, from and against any and all claims, demands, actions or causes of action for costs, expenses, or damages to personal property or personal injury, or death, which may result from my participation in this internship agreement. I understand and admit that my participation in this internship is voluntary. I assume full responsibility for any injuries or damages resulting from my participation in this program including responsibility for using reasonable judgment in all phases of participation of the program and travel to and from my internship location. I recognize and understand that the activities may be hazardous, that my participation is solely at my own risk, and that I assume full responsibility for any resulting injuries and damages. I affirm that I am in good health. I further declare that I am physically fit and capable to participate in this internship. I acknowledge that it is the recommendation of West Shore Community College that I obtain general medical/health insurance if I am not already covered. I understand that it is my responsibility to notify the appropriate person in the workplace of emergency medical information. I also understand that this Waiver of Liability and Release binds my heirs, executors, administrators, and assigns as well as myself. I acknowledge that I have read and understand this entire Waiver of Liability and Release, and I agree to be legally bound by it. I have submitted an Internship Agreement that bears my signature and represents my understanding of this agreement.
Hepatitis B Declination Statement:
The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine. The statement can only be signed by the employee following appropriate training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety, method of administration, and benefits of vaccination. The statement is not a waiver; employees can request and receive the hepatitis B vaccination at a later date if they remain occupationally at risk for hepatitis B.
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at a minimal charge to me at my local Health Department; however, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of
acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at a minimal charge to me at my local Health Department.