Hold Harmless Agreement & Liability Release Form
Hope of the Poor, Inc., hereinafter "Hope," understands that the proposed mission trip of either international or domestic origin in which you will or may be participating may potentially involve certain unavoidable risks to your physical or mental person. While these risks are real, they are usually rare. It is Hope's intent to minimize every risk that might impact you, and yet you must simultaneously acknowledge that in a foreign country context, Hope does not control the sanitation, the laws, or the degree to which laws are enforced in that country, and you must therefore recognize a certain element of risk. These risks include, but are not limited to, those involved in traveling to and within and returning from a foreign country; foreign political, legal, social, and/or economic conditions; different standards of design, safety, and maintenance of buildings, public places and/or conveyances; and local medical and weather conditions. Additional risks may also include automobile or bus accidents, contagious diseases, food poisoning, falls, airline accidents, strikes, military or political activity, equipment failure, assault, battery, robbery, injury, and death. If you are participating on a domestic trip at a location within the continental United States, although the risks are greatly reduced, this still does not guarantee a risk-free trip.
You, the participant, are encouraged to make your our own Investigation of the travel situation, and be willing to accept the above enumerated and described risks. Hope has investigated the particular risks that may be present in the area of your destination, but you, the participant, must understand that many of these risks are unpredictable, and are wholly outside the control of Hope, and may change and/or increase beyond what is now known, anticipated, or expected.
Additionally, because of the nature of our mission, although Hope monitors US Department of State Travel Warnings and Advisories, Hope does not limit trips solely based on a particular State Department Travel Warning and/or Advisory. Hope both encourages and urges you to refer to the Center for Disease Control (www.cdc.gov) and your healthcare provider for professional recommendations about Immunizations, disease prevention, and necessary medications for areas in which you will be traveling. Knowing the risks described here, and in consideration of being permitted to participate in this travel, you are required to assume all of the risks and responsibilities surrounding and attendant to your participation in this travel trip.
As a participant you must be aware that all foreign countries have their own laws and standards of acceptable conduct, including dress, manners, morals, politics, and behavior. Please recognize that behavior that violates those laws or standards could do harm to Hope's relationships with institutions therein, as well as your personal health and safety. To the greatest extent possible, you will be informed of, and must abide by, all such laws and standards for the country of your destination. Should problems arise, you may be required to attend to any legal problems you encounter with any foreign nationals or the government of that country. Hope is not responsible for providing assistance under these circumstances.
Accordingly I, the undersigned mission participant, having read and understood the risks described herein, and in consideration of being permitted to participate in this travel/mission agree to assume all of the risks and responsibilities surrounding my participation In this travel/mission. Also, to the maximum extent permitted by law, I do voluntarily and without reservation, release, hold save, protect and indemnify HOPE OF THE POOR, INC. a Nebraska nonprofit corporation, and its respective directors, officers, employees, agents, and representatives from and against any and all present or future claims, damages, expenses, actions, losses, or liabilities of all and whatever kind, including but not being limited to: injury to my physical or mental person, injury to my property, or injury for which I may be liable to any other person, entity or government whomsoever and whatsoever, relating in any way to my travel with Hope, arising out of or from any accident or other occurrence causing injury to any person or property caused by the negligence or other actions of Hope, or any other party including the individual risks identified, discussed, and assumed in this Agreement.
1. Before my departure, I will provide Hope and its representatives with complete and accurate physical and mental health information, as well as any personal data that may be necessary for Hope to arrange a safe and healthy trip experience for myself and/or other participants. I understand that Hope does not discriminate on the basis of any physical or mental disability; however, information regarding such disabilities is necessary for making reasonable accommodations.
2. I assume full responsibility for my care and safety during my participation In the Mission.
3. I assume full responsibility for my own official international travel documents, such as passports and visas. I also assume full responsibility for familiarizing myself and abiding by entry and exit requirements for foreign countries traveled to, including but not limited to passport validity, common and special visa requirements, regulations for allowable or prohibited goods, and items to be transported internationally. I acknowledge that Hope holds no responsibility for the denial of a visa, denial of foreign entry, denial of passport validity, or for any other anomaly (including loss of documents), that affects any portion of my travel on the trip. It is my responsibility to follow all relevant Immigration regulations of the host country, or countries visited.
4. I will inform myself of the local conditions, customs, and laws of the mission site that may present health, safety, or legal risks. Moreover, I will promptly report to my Hope Mission Director any health, safety, or legal concerns I have while abroad.
5. If I leave the Mission prior to its completion, Hope has no liability to provide or arrange for my transportation, housing, dining, or other services needed by me in connection with my early departure.
6. I will comply with all rules and regulations issued by Hope, the host Institution, and the host nation including, but not being limited to the following.
a. I will not buy, sell, or use Illegal drugs at any time;
b. I will not engage In the use of alcohol, except at the discretion of the Mission Director, when In accord with local customs and laws.
c. If I violate any rule, regulation or requirement, I understand that I may be sent home at my own expense.
7. Hope may, at its discretion, determine what circumstances within the host country may require the cancellation of a Mission. Hope will provide me with as much advance notice as possible of any such decision. I also understand that Hope's partner institution, if any, or the host government may prematurely terminate the trip. In that event Hope will provide me with assistance in arranging transportation back to the United States, again at my expense. However, Hope bears no liability for any losses or claims incurred by me resulting from a termination of the Mission. Hope is not obligated to provide any refund for cancelled or rerouted trips. If I choose to remain in the host country after receiving notice of the program's termination, I bear complete responsibility and liability for my own care and safety.
8. I will pay any and all required fees and charges that are applicable to Hope. I understand Hope's cancellation policies and fees, and agree to abide by them. This specifically includes the purchase of medical insurance judged appropriate by both Hope and the host institution. Moreover, I will submit proof of such insurance coverage before my departure. I am fully responsible for any costs not covered by my insurance.
9. I will turn over to Hope any awarded travel Insurance payments that exceed my own direct expenses incurred relating to such a claim.
10. I authorize Hope to contact my parents, or other family members in the case of an emergency, or when Hope deems it necessary. I will submit to Hope parental, relative, or other selected third party contact information before my departure. I also grant Hope the authority during the Mission to arrange for necessary emergency medical treatment, if a family member or other selected relative or third party contact cannot be reached.
11. If needed for health reasons, and I am incapacitated, I give permission to Hope (and thereby to its employees, agents or other representatives accompanying me on the Mission) to direct any evaluation, diagnosis, or treatment (including the administration of medication or other forms of treatment), in accordance With medical practice as recommended by licensed medical personnel. I relieve Hope of all responsibility and consequences that may arise as a result of this treatment. I will not hold Hope liable in the event of physical or mental Injury. Further, I agree to accept any and all financial responsibility as a result of the receipt of medical treatment.
I, the undersigned Hope Mission Participant, state that I have read and understand this entire Agreement, and agree to all of its terms and provisions.
Electronic Signature and Acknowledgement
Enter the date and your full name to acknowledge your electronic signature of this document.