Mission Team Waiver and Release

Mission Team Waiver and Release

In consideration of being allowed to participate in the trip sponsored by Mission To Haiti and in consideration of the benefits to be derived there from, I hereby release Mission To Haiti and its present and former officers, directors, employees, agents and their heirs, administrators, executors, successors and assigns from all claims and liabilities of any kind, where known or unknown, which arise from or are connected in any way with my participation or the participation of any member of my family including my spouse or minor children, in the trip.

I recognize that the conditions in some of the places to which I, my spouse, or my children will travel are not of the same standard as the conditions to which I am accustomed. I realize further that there are certain health risks as well as other risks to personnel and property, and I enter into participation in the trip and agree to the participation of my spouse or minor child with the knowledge of those risks. If for any reason I or my spouse or child is unable to complete the planned stay at the project, I assume full responsibility for expenses incurred for me or my spouse or my children in their safe return home.

In the event of an emergency, I hereby authorize a leader of this activity, as an agent for me or my spouse or my children to consent to: any x-ray examinations; medical, dental or surgical diagnosis treatment; hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state or country where services are rendered, either at the office of a doctor or in a hospital. I expect my family to be contacted as soon as possible.

I certify that I am of a lawful age and competent to agree to this Release, and have done so voluntarily.

I understand that this document constitutes a full and complete waiver of all possible claims for any act or omission, including claims for negligence regarding injury or property damage, arising out of my participation in the trip.

I understand that this Release applies to, covers, and includes unknown, unforeseen, unanticipated, and unsuspected damages, losses, or liabilities and the consequences thereof; which result from the matters hereinbefore inferred as well as those now disclosed and known to exist. The provisions of any state, federal, local, territorial law or statute providing in substance that releases shall not extend to claims or damages which are unknown or unsuspected to exist at the time are hereby expressly wavered by me.

Should any dispute or controversy arise, I agree to seek resolution according to Biblical principles.

NAME OF PARTICIPANT

PARENT OR GUARDIAN

RELATIONSHIP TO MINOR

DATE

I agree to accept the terms of this waiver.

Please print this form for your records before submitting

Mission To Haiti is registered in Florida as a 501(c)3 charitable organization. A financial statement
is available upon request. All gifts are tax deductable.