Beruflich Dokumente
Kultur Dokumente
As part of its commitment to favor the creation of the proper atmosphere to successfully follow
the Program, the Institution provides only limited medical services (such as administration of
non-prescription medications or referral to appropriate medical professionals) and a compulsory
individual health insurance policy, which includes health coverage according to the terms and
conditions set forth in said insurance policy (hereinafter, the Insurance Health Policy). The
Institution does not provide services other than those already mentioned. Prospective students
having a particular need should contact Berklees Student Affairs Office before enrolling in the
Program in order to confirm that all information required to let him /her find the way to satisfy
his/her need is available at our Student Affairs Office.
I understand that participation in the program is voluntary and that there is no requirement to
participate. I also agree to abide by directives and precautions given by college leaders or
officials.
I have read and understood the above provisions and voluntarily agree to be bound by them
STUDENT SIGNATURE
_______________________""
"
Date:"_______________________""
Student
!
!
!
!
!
!
"
"
Date:"_______________________""
I understand that references in this document to Berklee, the College, Berklee College of
Music, or the Valencia Campus, shall be deemed to refer to Berklee College of Music, Inc.
and Berklee Valencia, S.L.U., as well as any subsidiaries or parents of either.
I represent and acknowledge that:
I.
I have the necessary personal independence, maturity and both mental and
physical- health stability so as to enroll in the Program and follow and attend
efficiently all Program activities and tasks.
Should keeping such health stability require receiving specialized treatment in Spain,
I undertake to strictly follow such treatment under the supervision of specialized
health personnel in Spain and to instruct the specialized health personnel who have
supervised the treatment of a particular illness or disorder in my country to share all
relevant medical information they have with the specialized health personnel
supervising my treatment in Spain.
II.
I hereby acknowledge that the Institutions Dean is entitled to require from me at any
moment -whenever he considers that the seriousness of the circumstances so
requires- to show sufficient evidence, via a current medical certificate, that I have the
necessary mental and physical health stability to enroll in and follow the Program.
Failure to provide sufficient evidence may be a cause of dismissal.
III.
I agree to abide by all rules and procedures contained in the Student Handbook, the
Policy Handbook for Students 2014-2015 and Berklee internal policies, regulations
and rules. I acknowledge that, among others, conduct that may be cause of
dismissal from the Program include:
Unlawful conduct
Academic or personal misconduct
Acts involving dishonesty, fraud, deceit or misrepresentation
Acts or conduct involving harassment or discrimination, or threatening
behavior of any type.
IV.
In addition, I acknowledge and agree that the Institutions Dean (or another
representative professional from Berklee) is entitled, to take any action he may
consider appropriate, independently of any other internal disciplinary measures, in
order to protect my wellbeing and/or the wellbeing of other students if the institution
is aware of any risk situation such as (but not only):
V.
-
VI.
Dangerous mental health symptoms that may cause you lose your
personal independence or seriously damage a functional and healthy
lifestyle.
I acknowledge and agree that Berklee College of Music or Berklee Valencia is not
responsible for any of my health problems or the care or assistance I may need
during the Program. I further agree that all expenses and liability for expenses
incurred with respect to my health or the care or assistance I may need during the
Program shall be fully assumed by me if not covered by the Health Insurance Policy.
Berklee College of Music and Berklee Valencia are not liable to any damage caused
by entities or persons recommended by Berklee Counseling Services or by health
institutions or personnel under the Health Insurance Policy.
The information I provided on this form is true and correct to the best of my knowledge.
As a prospective student of the Program, I understand my responsibilities. My signature at the
end of the document indicates that I have read and acknowledge each statement, and my
intentions to comply with Berklee procedures and rules at all times and with this document. Noncompliance may result in being dismissed from the Program.
Upon signing this document I acknowledge that I have read and that I accept the Student
Handbook and the Policy Handbook for Students 2014-2015
STUDENT SIGNATURE
_______________________""
"
Date:"_______________________""
Student
"
"
Date:"_______________________""
_______________________"Date:"_______________________" "
"
!
!
Berklee!College!of!Music!
!
Consent'forEmergency'Medical'Treatment'Form'
!
!
*This'form'is'mandatory'for'all'students.'Please'print'clearly.!
!
Student!First!Name:!_______________________Last!Name:______________________________!
!
Date!of!Birth:!_______________________________________!
!
!
I understand that enrolling in and participating in an international program such as the Valencia Summer
Performance Program comes, as many other activities in the life, with potential for risk of danger to me and I am
willing to assume such risks, I agree that I will not hold Berklee College of Music, Inc., or Berklee Valencia S.L.U.
or any of their employees, agents, trustees, officers, subsidiaries, or parent companies responsible for any
damage, costs, liability, or personal injuries caused or sustained by me during any Programs activities.
!
!
EMERGENCY'CONTACT(S)'(At!least!one!parent/legal!guardian!is!required!to!be!listed!below!for!students1!under!
age!18)!
Name:!________________________________!!!!Name:!________________________________________!
!
Daytime!Phone:!__________________________!Daytime!Phone:!_________________________________!
!
Evening!Phone:!!_________________________Evening!Phone:!_________________________________!
!
!
FITNESS'FOR'PARTICIPATION'
!
I!hereby!certify!that!the!above!named!student!is!physically!fit!to!participate!in!the!above!named!Program.!!!
I!understand!that!the!Activity!is!voluntary!and!that!there!is!no!requirement!to!participate.!!
!
!
__________________________________________________!! _________________________________!
(Signature!of!student)!
Dated!
!
__________________________________________________!! _________________________________!
(Signature(s)!of!Parent(s)/Legal!Guardian(s))!if!student!is!under!age!18!
Dated!
!
!
MEDICAL'TREATMENT'CONSENT''
'
I! consent! to! emergency! medical! treatment! if! it! is! determined! to! be! necessary! by! college! official! following! the!
opinion!of!a!licensed!medical!professional!and!do!hereby!authorize!the!staff!of!Berklee!College!of!Music!to!obtain!
medical! attention! for! the! above! named! student! should! a! medical! concern! arise! that,! in! the! opinion! of! a! licensed!
medical! professional,! requires! attention.! I! do! hereby! give! consent! to! any! necessary! examination,! anesthetic,!
medical!diagnosis,!surgery!or!treatment,!and/or!hospital!care!to! be!rendered!to!the!aboveQnamed!student!under!
the! general! or! special! supervision! and! on! the! advice! of! any! licensed! medical! professional! during! the! program!
period.!I!accept!responsibility!for!payment!of!all!services!rendered;!I!authorize!any!medical!facility!which!renders!
services! to! release! medical! information! necessary! for! the! processing! of! insurance! claims! or! treatment;! and! I!
authorize! the! payment! of! insurance! claims! directly! to! the! medical! facility.! I! understand! that! whenever! possible,!
Berklee!College!of!Music!staff!will!make!a!good!faith!effort!to!contact!the!aboveQnamed!person(s)!before!seeking!
treatment.!If!this!is!not!possible,!I!understand!that!the!staff!will!notify!such!person(s)!as!soon!as!possible!of!any!and!
all!diagnoses!and!treatments.!
!
I! do! hereby! release! and! forever! discharge! Berklee! College! of! Music! and! its! employees,! agents,! officers,! trustees,!
affiliates!and!representatives!from!any!and!all!liability!of!any!kind!for!any!claim,!demand,!action,!cause!of!action,!
expense,!judgment!or!cost,!including!without!limitation!attorneys!fees,!which!arise!out!of!or!relate!in!any!manner!
to! the! exercise! of! authority! or! judgment! pursuant! hereto,! or! to! the! securing,! oversight,! administration! or!
supervision! of! medical! or! other! care! or! treatment! on! behalf! of! the! student! at! any! time! or! any! travel! incident!
thereto.!
(Please'note:!Our!staff!cannot!administer!any!medications,!prescription!or!nonQprescription!to!program!attendees.!The!
Berklee!Medical!Assistance!team!may!administer!nonQprescription!medications,!to!students!over!the!age!of!18!and!only!after!
speaking!with!a!parent!or!guardian!of!students!under!the!age!of!18.!If!the!student!will!need!to!take!prescription!medications!
while!attending!the!program,!s/he!must!assume!responsibility!for!taking!the!medication!as!needed!or!indicated.)
!
!
__________________________________________________!! _________________________________!
(Signature!of!student)!
Dated!
!
__________________________________________________!! _________________________________!
(Signature(s)!of!Parent(s)/Legal!Guardian(s))!if!student!is!under!age!18!
Dated!
!
!
! 2
(month)
(year)
___________________________________________
___________________________________________
______________________________________