FSC Learning Contract and Liability Waiver

Learning Contract

This form is intended to be used by Florida Southern College students to report all on and off-campus experiences. Questions should be directed to careercenter@flsouthern.edu.
This agreement is meant to provide guidelines for student internship programs and professional observation experiences and is not meant as a binding, legal document.
Type of experience*
Year in which you are completing this experience*
ex. 2023
Semester & Year in which you are completing this experience*
If your experience is not within these dates, please call the Office of Career Services - 863.680.4390
Are you seeking academic credit for this internship or experience?*

YesNo
If seeking academic credit, number of credit hours requested*
If seeking academic credit, course you intend to register for*
Student Information
Full Name*

First NameLast Name
Student ID*
Classification*
Preferred Name
Preferred E-mail*
example@example.com
Student Cell Number*

Area CodePhone Number
Faculty Advisor Name*

First NameLast Name
Faculty Advisor E-mail*
example@example.com
Faculty Advisor Phone Number*

Area CodePhone Number
Major that this internship or experience is being used for*

Internship or Experience Details
Name of Organization or Site*
Title of position or experience*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Total number of hours that will be completed during this internship or experience*
Internship or experience compensation*

PaidUnpaid
If internship or experience is paid, compensation per hour will be*
ex: $15/hr
Student Responsibilities*
Please indicate all responsibilities held at your position.
Experience Goals*
Please list at least 4 goals.

Supervisor Information
Name of Organization or Site*
Supervisor Title*
Supervisor Name*

First NameLast Name
Supervisor First Name*
First Name
Supervisor Last Name*
Last Name
Supervisor Email*
Must be a work email address. @gmail.com, @hotmail.com, etc..are not allowed.
Supervisor Phone Number*
Street Address*
Street Address Line 1
Street Address 2
Street Address Line 2
City*
City
State*
State
Zip Code*
Zip Code
Country*
Country
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Student Signature
Conditions
The student attests that they meet all eligibility requirements and agree to abide by all requirements set forth by FSC, their respective department, and FSC Faculty Advisor or Internship Coordinator (if applicable). The students acknowledges that
their Mentor may not be a relative. The student also agrees to work under the close observation of mentors at the Site and abide by ethical and professional guidelines set down by the Site, especially respecting confidential agency and clientele information.

Unless advised otherwise, students are not entitled to a job at the conclusion of the experience. Additionally, unless payment has been expressly provided by the Site, the student agrees that they are not entitled to wages or other compensation other than their experience and learning for the time spent as a student for the Site, the experience does not create an "employment" relationship under the Fair Labor Standards Act ("FLSA") or any other definition, and the FLSA's minimum wage and overtime provisions do not apply. Furthermore, remote positions are subject to approval by your respective department.

All students acknowledge responsibility for their actions and commit themselves to the highest standards of academic and personal integrity and will model excellence of character as outlined in the FSC Honor Code. The Honor Code specifically applies to all situations in which students represent the college or themselves as students of the College, even when classes are not in session.

The student also agrees to participate in actives dictated by their FSC Faculty Advisor or Internship Coordinator, complete the post-experience survey sent by the FSC Office of Institutional Research, and will encourage their Mentor to complete the Evaluation of the Student at the end of the experience.

The FSC Faculty Advisor or Internship Coordinator, if applicable, agrees to provide mentorship and guidance regarding all academic components of the experience.
I have read the internship job descriptions and I fully understand the requirements, pay if any, and employment start and end dates.*

Yes
By signing below, you confirm your understanding of the information indicated above and agree to abide by the terms of this agreement. Any major modifications will be in writing and agreed to by all parties.
Student Signature *

Clear
Waiver of Liability, Assumption of Risk & Indemnity Agreement

On and Off-Campus Experiences
Student ID*
Student First Name*
First Name
Student Last Name*
Last Name
Title of position or experience*
Name of Organization or Site*
Describe if this is for a Class, Experience, or Activity*
Semester in which you are completing this experience*
Year in which you are completing this experience*
ex. 2023
Date

MonthDayYear
Date
Student Age (as of today's date)*

FLORIDA SOUTHERN COLLEGE STUDENT INTERNSHIP INSURANCE COVERAGE, PERSONAL CONDUCT, ASSUMPTION OF RISK, WAIVER OF LIABILITY, COVENANT NOT TO SUE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
In consideration for and as a prerequisite of my participation in a student internship or experiential learning activity during my admission at FSC, hereinafter referred to as “The Activity”, I hereby knowingly and fully enter into this STUDENT INTERNSHIP INSURANCE COVERAGE, PERSONAL CONDUCT, ASSUMPTION OF RISK, WAIVER OF LIABILITY, COVENANT NOT TO SUE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT.

I acknowledge that FSC itself does not control the way in which the activity and activity site is structured and operates. In granting credit for this activity FSC affirms that, to the best of its judgment, the experience is an appropriate curricular or co-curricular option for students in a liberal arts program of study and worthy of FSC credit but makes no other assurances, representations, expressed or implied, about any travel and living arrangements the student has made.

FSC does not knowingly approve activities that pose undue risks to their participants. However, any activity or travel carries with it potential hazards which are beyond the control of FSC its agents and employees.

1. INSURANCE COVERAGE
I have sufficient health, accident, disability, and hospitalization insurance to cover me during the activity; I further understand that I am responsible for the costs of such insurance and for the expenses not covered by this insurance, and I recognize that FSC does not have an obligation to provide me with such insurance.

I assume full responsibility for any undisclosed physical or emotional problems that might impair my ability to complete the activity.

I understand that if I use my personal vehicle for the benefit of or during the activity, FSC, as further stated herein, has no liability for personal injury or property damage which may result from that use. I agree to rely solely on my personal vehicle insurance coverage and on any insurance coverage provided by the activity agency.

I understand that I will not be entitled to unemployment compensation benefits
upon completion of the activity.

As stated further herein, I understand that FSC assumes no liability from any
personal injury that I may suffer in the course of the activity and that I have released FSC from any liability, and I agree that it is my responsibility to ascertain whether the activity agency provides workers compensation coverage for me.

2. PERSONAL CONDUCT
I understand that the responsibilities and circumstances of an off-campus
activity may require a standard of professional decorum. Therefore, I indicate my willingness to understand and conform to the professional standards of the activity site.

I further understand that it is important to the success of the present activity and continuance of further activities that students observe standards of conduct that would not compromise FSC in the eyes of individuals and organizations with which it has dealings.

I acknowledge that the activity site Liaison and/or FSC Career Center personnel has the responsibility for setting rules and interpreting conduct for this purpose. I acknowledge that other than the above, FSC, does not have the right to control the daily activities of the student internship. I agree that should the activity site Liaison and/or the FSC Career Center personnel decide that I must be terminated from my activity because of conduct that might bring the program into disrepute, or the internship into jeopardy, that decision will be final and may result in loss of credit.

3. ASSUMPTION OF RISK
I understand that there are certain risks involved in the participation in a student activity. I am aware of a number of potential risks to my personal safety, all of which are beyond FSC's control. These risks include, but are not limited to, travel, the absence of telephones or other means of prompt communication in the community where I may travel, long distances that may separate me from emergency and law enforcement services, sub-standard conditions, exposure to detrimental health conditions, including exposures to illness resulting in death. I acknowledge that it is my responsibility to educate myself of the risks involved with my student internship that I may be exposed to while in service and I acknowledge that these risks exist and assume responsibility for such risks during my participation in the activity. I have made my own investigation of the stated and unstated risks, understand these risks, and assume them knowingly, willingly and voluntarily.

4. WAIVER OF LIABILITY AND COVENANT NOT TO SUE
I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE
FSC, its board, officers, administrators, servants, agents, coaches, and/or employees (hereafter collectively referred to as RELEASEES) from any and all liability, claims, demands, actions, and causes of action, whatsoever arising out of or related in any way to any loss, damage, sickness, injury, including but not limited to death, that may be sustained by me or to my property belonging to me WHETHER CAUSED BY ANY NEGLIGENCE, SIMPLE OR GROSS, OF THE RELEASEES, or otherwise, while participating in all aspects of the activity.

5. INDEMNITY AND HOLD HARMLESS
I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE
RELEASEES from any loss, liability, damage, or cost, including court costs and attorney's fees that may be incurred due to my participation in the student internship activity, WHETHER CAUSED BY THE NEGLIGENCE, SIMPLE AND/OR GROSS, OF THE RELEASEES, or otherwise. This agreement to indemnify and hold harmless includes claims made by me, my parent or others arising out of injury to me and/or others arising from in any way my participation in the student internship.

6. SEVERABILITY
I further expressly agree that this Waiver and Assumption of Risk Agreement (the Agreement”) is intended to be as broad and inclusive as is permitted by the laws of the State of Florida and that if any portion of the Agreement is held to be invalid, that the balance shall, notwithstanding, continue in full legal force and effect.

7. KNOWING AND VOLUNTARY EXECUTION
It is my intent that this Assumption of Risk, Waiver of Liability and Covenant Not to Sue, Indemnification, and/or Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased, and shall be deemed as a complete assumption of risk, release, waiver of liability, covenant not to sue, indemnification, hold harmless agreement, and covenant not to sue the above-named RELEASEES as set forth herein. I hereby further agree that this Student Internship Insurance Coverage, Personal Conduct, Assumption of Risk, Waiver of Liability, Covenant Not To Sue, Indemnification, and Hold Harmless
Agreement shall be construed in accordance with the laws of the State of Florida.

In signing this Student Internship Insurance Coverage, Personal Conduct
Assumption of Risk, Waiver of Liability, Covenant Not To Sue, Indemnification and Hold Harmless Agreement, I acknowledge and represent that: I have read this form in its entirety, understand it, and sign it voluntarily as my own free act and deed; no oral representations have been made to me different than what is contained in this document; I am at least eighteen (18) years of age and fully competent; I execute this Student Internship, Insurance Coverage, Personal Conduct, Assumption of Risk, Waiver of Liability, Covenant Not To Sue, Indemnification and Hold Harmless Agreement for full, adequate and complete consideration, fully intending to be bound by the same.
By signing below, you confirm your understanding of the information indicated above and agree to abide by the terms of this agreement. Any major modifications will be in writing and agreed to by all parties.
Parent or Legal Guardian (if student is under 18 years of age)

Clear
Student Signature *

Clear
Should be Empty:

Learning Contract

Student Information

Internship or Experience Details

Supervisor Information

Student Signature

Waiver of Liability, Assumption of Risk & Indemnity Agreement

FLORIDA SOUTHERN COLLEGE STUDENT INTERNSHIP INSURANCE COVERAGE, PERSONAL CONDUCT, ASSUMPTION OF RISK, WAIVER OF LIABILITY, COVENANT NOT TO SUE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT