1. Introduction
This is a release of liability and an
authorization regarding medical care and the use of photographs of me. By
signing below, I am agreeing to release Beyond the Walls (BTW) and its representatives
from liability. I am also granting permission to BTW and its representatives to
seek and obtain medical care in the event of my illness or injury. I have,
therefore, been advised to read this document carefully and understand that I
have the opportunity to consult with an attorney before signing.
It is my understanding that participation in
this Short Term Mission Trip (Trip) to Guatemala sponsored by Beyond the Walls
is a privilege. I also acknowledge that one reason that I am participating in
the Trip is to obtain spiritual and other benefits afforded by BTW that are in
accordance with its goals. In consideration for the privilege of
participating in this Trip, I am signing this Release of Liability and
Permission Regarding Medical Care form (Release). I acknowledge that my
participation in this Trip may involve certain risks of physical injury,
illness, or death, including risks of which I may not currently be aware, and
I hereby agree to assume such risks.
2. Release and Indemnification
I hereby agree to release and hold harmless
BTW, members of its governing board, and its officers, employees, members,
volunteers, and agents (collectively, “the Released Parties”) and to discharge
and waive any and all claims, demands, losses, damages, and liabilities with
respect to any and all property damage, personal injury and/or death arising
from my participation in this Trip. The foregoing sentence shall apply (without
limitation) to all claims, demands, losses, damages, and liabilities described
therein, whether known or unknown, foreseen or unforeseen, future or
contingent, except claims, demands, losses, damages and liabilities arising out
of the sole and exclusive gross negligence or willful misconduct of one or more
of the Released Parties. I further covenant not to sue any of the Released
Parties in connection with any of the claims, demands, losses, damages, or
liabilities described above.
I further agree to indemnify, save, and hold
harmless the Released Parties from any and all claims, demands, losses,
damages, and liabilities for indemnities, contribution or other otherwise with
respect to any and all property damage, personal injury and/or death arising
from my participation in this Trip, as may be asserted by a third party
(defined as any party other than the Released Parties or me), except to the
extent such a claim might be based upon the sole and exclusive gross negligence
or willful misconduct of one or more of the Released Parties.
3. Authorization for Medical Care
I attest and certify that I have no known
medical conditions that would prevent me from participating in this Trip. I
understand that BTW provides insurance coverage that is intended to cover
emergency medical expenses associated with accidental injury or illness not
related to a pre-existing condition that may occur while I am outside the
United States.
In case I am in need of medical or surgical
treatment to protect my health and welfare while participating in this Trip, I
authorize and agree to allow any authorized agent or employee of BTW to consent
to and authorize the administration of such necessary medical and/or surgical
treatment. I acknowledge and agree that the release of liability, hold
harmless, and indemnification provisions set forth in Section 2 above shall
apply to any authorization and consent to medical or surgical treatment made on
my behalf by BTW or its authorized agents or employees. If I am a minor or a
signatory to this Release for a minor, I understand that efforts will be made to
contact a parent/guardian before these actions are taken, but that in an
emergency such actions may be taken in the event a parent/guardian is unable to
be contacted.
Mediation/Arbitration
BTW and I agree that, should a claim or dispute
arise from my participation in this Trip, it shall be settled by biblically
based mediation and, if necessary, legally binding arbitration under a
mediation or reconciliation process in accordance with the Guidelines for
Christian Conciliation and associated Rules of Procedure promulgated by
Peacemakers Ministries Inc. of Billings, Montana, USA, or its successor. The
venue for such mediation, conciliation and arbitration process shall be Mendham,
New Jersey, or such other location as agreed upon by both parties. Judgment upon
an arbitration award may be entered in any court otherwise having jurisdiction.
Miscellaneous
I grant to Beyond the Walls, Potter’s
House—Guatemala, and Potter’s House--International permission to use in their
printed materials and on their respective web sites and other digital media
photographs and/or videos taken of or by me during the Trip or during
trip-related activities.
I expressly waive any defense to the
enforcement of any provision of this Release arising from a claim of lack of
consideration. In the event that any provision of this Release is determined to
be invalid or unenforceable, the remainder of the provisions shall remain in
full force and effect as if this Release had been executed with the invalid
provision eliminated. I understand and agree that this Release is intended to
be as broad and inclusive as permitted under applicable law.
The undertakings and covenants of this Release
shall be binding upon me, my family, heirs, next of kin, legal representatives,
beneficiaries, successors, and assigns. This Release shall be interpreted in
accordance with the laws of the State of New Jersey. The terms of this Release
are contractually binding and are not a mere recital.
This Release shall be
effective and binding upon me. I have read this Release and understand its
terms. I further represent that I am at least 18 years of age and am not a
minor in my State of residence or, if I am a minor in such State, that
both
of my parents or my legal guardian have signed this form in the Consent
section below
acknowledging this Release and accepting its terms on my
behalf.