SECURE Externship Site Agreement In placing our students from UDA in externships atExternship Site Name*The Externship Site agrees to the following statements: • Maintain a safe working environment and inform students of risks related to different activities so that students can knowledgeably agree to participate. • Comply with federal and state laws regarding nondiscrimination and sexual harassment in the workplace. • Follow Labor and Industries requirements regarding fair labor standards, particularly as they relate to paid and unpaid externships. • Complete the externship evaluation form provided by UDA and allow students the opportunity to perform the skills listed on the form. • Contact UDA immediately if there are any issues or problems with any students. • Externship site will always have the students under the supervision of a licensed dentist per Unity Dental Assisting’s professional liability policy requirements. Unity Dental Assisting agrees to the following statements: • UDA will maintain a professional liability policy that covers the students at all externship sites. In addition, each party to this Agreement agrees that: • Both parties shall indemnify, defend and hold harmless the other, its agents and employees from and against any and all claims, damages, liabilities, losses and expenses including, without limitation, attorneys’ fees and costs of any kind whatsoever arising out of or resulting from, directly or indirectly, any act or omission of its agents, employees, invitees, contractors, suppliers, and customers.Name of Authorized Party at Internship Site*Title*Email* I agree I understand that checking this box and signing below constitutes a legal signature confirming that I acknowledge and agree to the above. Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.