Mision Para Los Niņos Inc.
Release and Waiver of Liability
I, the undersigned, hereby acknowledge and confirm that I have voluntarily applied to participate in a mission to the Dominican Republic ("Trip") coordinated by Mision Para Los Ninos Inc. presently of San Jose Adentro, Dominican Republic. In consideration of receiving permission to participate, in any capacity, in any aspect of the Trip, each of the undersigned releases Jack Meibaum, and their agents, officers, members, and employees, of and from any and all liability, claims, demands, actions, and causes of action, arising out of or related to any loss, damage, or injury, including death, ("Loss") that may be sustained by any or each of the undersigned, or any property of any or each of the undersigned, while on, preparing for, or retuning from the Trip or any aspect of the Trip. This release and waiver shall apply whether or not any Loss is cause by the negligence of any of the persons or organizations named.
Each of the undersigned acknowledge that he/she is duly aware of and has voluntarily assumed the risks and hazards of travel and foreign missions activity and in participating in this Trip, including hazards of work in a remote location without communication and medical care facilities comparable to those of the U.S. and with access difficulties of a remote location without institutional sponsorship. This release shall be binding upon the heirs, next of kin, executors and administrators of each of the undersigned.
In signing the foregoing release, each of the undersigned acknowledges and represents:
That he [she] is a citizen of the United States of America and is lawfully able to travel to all locations contemplated for the Trip.
That he [she] has read the above release and waiver, understands it, and signs voluntarily;
That he [she] is over 18 years of age and of sound mind, or that, if under age 18, each parent / guardian voluntarily joins in this agreement and has signed below.
That he [she] is not participating in the trip as agent, servant, or employee of any other person.
Signed:_____________________________ Dated: ________________ Witness: __________________
For any person under age 18, the signature(s) of each parent or legal guardian is (are) below:
Signed:_____________________________ Dated: ________________ Witness: __________________
Signed: _____________________________Dated: ________________ Witness: __________________