Pre Existing Condition Waiver And Release I printable pdf download

Global B rigades, I nc.

1099 E . C hamplain D rive

Suite A -‐176

Fresno, C A 9 3720

Tel: 2 06-‐489-‐4798

PRE-EXISTING CONDITION WAIVER AND RELEASE

I, _________________________, the undersigned, hereby acknowledge and represent that I am

over eighteen (18) years of age and have been informed by a licensed physician that I have the

following physical condition(s):

______________________________________________________________________________

Notwithstanding the above condition(s), I hereby represent and agree to the following:

I have been medically cleared by a licensed physician to participate in the Global

Brigades program specified below, and agree to provide written confirmation of said

clearance upon request.

I understand that during the course of my Brigade trip, I may be required to participate in

physically demanding activities. I also understand that I will be in a foreign country and

will be exposed to situational stressors such as changes in climate, unfamiliar and rocky

terrain, and unfamiliar foods. Lastly, I understand the risks of illness, infection, and

disease in the regions in which I am traveling.

I understand that the country to which I am traveling may not have the same or adequate

levels of medical care, including treatments, procedures, and medications that are

available in my home country for the treatment of my pre-existing condition(s).

I fully understand that my participation in the Global Brigades program specified below

may result in the deterioration or aggravation of my pre-existing condition(s).

Nonetheless, I acknowledge and accept the risks and desire to continue with my

participation in the Global Brigades trip.

In light of the foregoing, I hereby fully waive, release, hold harmless, and discharge

Global Brigades and all its related affiliate entities, companies and/or organizations, as

well as its respective officers, employees, agents, representatives and volunteers

(individually and in their official capacities) from any and all claims, judgments, liability,

and any and all losses, damages, and expenses related to any injuries and illnesses, and

any and all manners of personal injury including death and permanent disability, arising

out of or in any manner related to my participation in, and travel to and from the Global

Brigades trip.

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Pre Existing Condition Waiver And Release I