Fillable Accident Waiver And Release Of Liability Form printable pdf download

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES

ASSOCIATED WITH THE VOLUNTEER MISSION TRIP TO GUATEMALA SCHEDULED TO

BEGIN ON ________ (the “VMT” or the “Activity”), including by way of example and not limitation, any

risks that may arise from negligence or carelessness on the part of the persons or entities being released,

from dangerous or defective equipment or property owned, maintained, or controlled by them, or because

of their possible liability with or without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in the VMT, and

have not been advised to not participate by a qualified medical professional. I certify that there are no

health-related reasons or problems which preclude my participation in this VMT.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the sponsors and

organizers of the Activity in which I may participate, and that it will govern my actions and responsibilities

at said Activity.

In consideration of my application and permitting me to participate in this VMT, I hereby take action for

myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to,

liability arising from the negligence or fault of the entities or persons released, for my death, disability,

personal injury, property damage, property theft, or actions of any kind which may hereafter occur to

me including my traveling to and from this VMT, THE FOLLOWING ENTITIES OR PERSONS: The

International Esperanza Project (“IEP”) and/or its directors, officers, employees, volunteers,

representatives, agents and assigns, and the VMT sponsors, and volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons

mentioned in Paragraph (A) above from any and all liabilities or claims made as a result of

participation in this VMT, whether caused by the negligence or fault of such entities or otherwise.

I acknowledge that IEP and its directors, officers, volunteers, representatives, agents, and assigns are NOT

responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific

activity on their behalf.

I acknowledge that this VMT may involve a test of my physical and mental limits and carries with it the

potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused

by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of

hydration, and actions of other people including, but not limited to, participants, volunteers, and/or

sponsors of the VMT.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury,

accident, and/or illness during this VMT, and I agree to be financially responsible for any costs incurred as

a result of such treatment. I am aware and understand that I should carry my own health insurance.

I understand while participating in this VMT, I may be photographed. I agree to allow my photo, video, or

film likeness to be used for any legitimate purpose by IEP, the VMT sponsors, organizers, and assigns.

This Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and

waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT.

I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF

MY OWN FREE WILL.

________________________________ ___________ __________________________________ ______

Participant’s Signature

Date

Participant’s Name

Age

(Please print legibly.)

________________________________ ___________

Parent/Guardian Signature

Date

(If under 18 years old, Parent or Guardian must also sign.)

Accident Waiver And Release Of Liability Form

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