ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY
I UNDERSTAND, ACKNOWLEDGE, AND AGREE AS FOLLOWS:
NOTICE: THIS IS A LEGALLY BINDING AGREEMENT WHICH IS INTENDED TO
PROVIDE A COMPREHENSIVE RELEASE OF LIABILITY, BUT IS NOT
INTENDED TO ASSERT ANY CLAIMS OR DEFENSES WHICH ARE
PROHIBITED BY LAW.
By signing this Release, you give up any right you may have to bring a court
action to recover compensation or obtain any other remedy for any illness or
injury to yourself or your property or for any death however caused against
Medical Missions South Haiti, Liberty Chapel, or Michael Blood M.D. arising out of
your participation as a volunteer on a mission trip to the country of Haiti.
My participation in such activity is entirely voluntary and I understand that any
and all such participation in volunteer work can result in harm, loss, damage,
illness, personal injuries or even death.
In consideration of the foregoing, I hereby assume all risks and waive, release
and discharge forever Medical Missions South Haiti, Liberty Chapel or Michael
Blood MD, its successors, agents and assigns, from any and all liabilities, claims,
damages, demands, or causes of action of any nature, whether known or
unknown, for any harm, loss, damage, illness, injuries or death, due to the
negligence or any other cause, resulting from, arising out of, or in any way
related to my participation as a volunteer on a mission trip to the country of Haiti.
I REPRESENT AND ACKNOWLEDGE THAT I HAVE READ THIS ASSUMPTION
OF RISK, RELEASE AND WAIVER OF LIABILITY AND FULLY UNDERSTAND
EACH AND EVERY PROVISION AND THAT I AM SIGNING THIS AGREEMENT
OF MY OWN FREE WILL AND ACCORD.
Participant’s Name (Printed):__________________________________
Participant’s Signature*:______________________________________
Date Signed:_______________________________________________
*If participant is a minor (under the age of eighteen (18) years), this form must be
signed by the minor’s parent or guardian
I UNDERSTAND, ACKNOWLEDGE, AND AGREE AS FOLLOWS:
NOTICE: THIS IS A LEGALLY BINDING AGREEMENT WHICH IS INTENDED TO
PROVIDE A COMPREHENSIVE RELEASE OF LIABILITY, BUT IS NOT
INTENDED TO ASSERT ANY CLAIMS OR DEFENSES WHICH ARE
PROHIBITED BY LAW.
By signing this Release, you give up any right you may have to bring a court
action to recover compensation or obtain any other remedy for any illness or
injury to yourself or your property or for any death however caused against
Medical Missions South Haiti, Liberty Chapel, or Michael Blood M.D. arising out of
your participation as a volunteer on a mission trip to the country of Haiti.
My participation in such activity is entirely voluntary and I understand that any
and all such participation in volunteer work can result in harm, loss, damage,
illness, personal injuries or even death.
In consideration of the foregoing, I hereby assume all risks and waive, release
and discharge forever Medical Missions South Haiti, Liberty Chapel or Michael
Blood MD, its successors, agents and assigns, from any and all liabilities, claims,
damages, demands, or causes of action of any nature, whether known or
unknown, for any harm, loss, damage, illness, injuries or death, due to the
negligence or any other cause, resulting from, arising out of, or in any way
related to my participation as a volunteer on a mission trip to the country of Haiti.
I REPRESENT AND ACKNOWLEDGE THAT I HAVE READ THIS ASSUMPTION
OF RISK, RELEASE AND WAIVER OF LIABILITY AND FULLY UNDERSTAND
EACH AND EVERY PROVISION AND THAT I AM SIGNING THIS AGREEMENT
OF MY OWN FREE WILL AND ACCORD.
Participant’s Name (Printed):__________________________________
Participant’s Signature*:______________________________________
Date Signed:_______________________________________________
*If participant is a minor (under the age of eighteen (18) years), this form must be
signed by the minor’s parent or guardian
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |