Medical School

Online Confirmation for Mobile Clinic Expeditions

Confirmation and Indemnity Form

Please read carefully and confirm.

Fields marked with an * are required

Student ID *

First Name *

Last Name *

Expedition Date *

Whilst attending any visit or field trip organized by the University of Nicosia's Medical School as part of any Mobile Clinic Expeditions or activities, I agree to comply with all reasonable requests made by the faculty / staff member in charge of the visit or the responsible person at the site/location of the visit and will ensure, as far as is reasonably possible, to comply with all Health and Safety requirements to protect my personal property and well-being as well as the property and well-being of third parties. I hereby acknowledge that the University of Nicosia Medical School accepts no responsibility for any injury, loss or damage to any natural or legal person or property during the travel/journey to or from the visit site/location and that, at all times, I will take all reasonable steps to ensure my personal safety and well-being as well as that of others.

Please note that photography and/or video recording will be undertaken during the event. I therefore grant UNIC Medical School (UNMS) permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by UNMS, in perpetuity, and for other use by UNMS. I will make no monetary or other claim against UNMS for the use of the interview and/or the photograph(s)/video

I confirm my participation. Failure to confirm within the deadline, as mentioned in the specific expedition call, will result to the removal of your name from the list of participants and your place will be given to another student on the waiting list.