Release & Liability Form

Release & Liability Form

  • Emergency Contact

  • Medical Information

  • Personal Physician Information

  • Medical Insurance Information

  • Release and Waiver of Liability

  • THIS RELEASE AND WAIVER OF LIABILITY (herein "Release") is executed on the below date by the undersigned volunteer (herein "Volunteer") in favor of New Hope Uganda Ministries, a non-profit 501c3, its directors, officers, employees, and agents (collectively "New Hope Uganda"). The Volunteer desires to provide volunteer services for New Hope Uganda and engage in activities related to being a Volunteer. The Volunteer understands that no compensation is expected in return for services provided; that New Hope Uganda will not provide any benefits traditionally associated with employment to the Volunteer; and that the Volunteer is responsible for their own insurance coverage in the event of personal injury or illness as a result of the Volunteer's services. As an inducement to New Hope Uganda to accept the Volunteer's scope of volunteer work, the Volunteer does hereby freely execute this Release with understanding and acknowledgment of the following terms:

    1. Waiver and Release: The Volunteer does hereby and forever discharge and hold harmless New Hope Uganda and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or equity, which arise or may hereafter arise, either directly or indirectly, as a result of Volunteer's work for New Hope Uganda. The Volunteer understands and acknowledges that this Release discharges New Hope Uganda from any liability or claim that the Volunteer may have against New Hope Uganda with respect to any bodily injury, illness, death, and/or property damage that may result from the Volunteer's work for New Hope Uganda, whether caused by the negligence of New Hope Uganda or its officers, directors, employees, other volunteers, agents, or otherwise.

    2. Assumption of Risk: The Volunteer recognizes that the conditions in some of the places in which New Hope Uganda may travel to provide physical and spiritual care are not equal to the same standard of conditions for which most of us are accustomed. The Volunteer further understands there are certain health and detainment risks to self and property and hereby fully enters into participation of the New Hope Uganda mission with knowledge of these risks. The Volunteer will make every reasonable effort to be knowledgeable and respectful of the host country's culture and people. The Volunteer acknowledges there may be certain risks and hazards that could involve dangerous and/or hazardous activities and expressly assumes the risk of any injury or harm from such activities. Further, the Volunteer agrees to practice safe travels and at all times act in accordance expected of a professional while working as a Volunteer for New Hope Uganda.

    3. Photographic Release: The Volunteer does hereby grant and convey unto New Hope Uganda the right to freely reproduce and/or circulate any photographs or other recordings of the Volunteer for any lawful purpose. The Volunteer shall not be entitled to any compensation, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

    4. Privacy and Confidentiality: The Volunteer agrees to maintain the privacy and confidentiality of those individuals served, their families and/or host families, as well as to the other Volunteers involved with New Hope Uganda during the course of a mission, as reasonably appropriate. Some sensitivity with regard to a host country may also be required under certain circumstances.

    5. Medical Treatment: As a Volunteer, I hereby release and forever discharge New Hope Uganda from any claim whatsoever that arises or may hereafter arise for any first-aid treatment and/or other medical services rendered in connection with treatment and/or an emergency during my Volunteer tenure with New Hope Uganda. As a Volunteer, I understand that New Hope Uganda does not assume any responsibility for providing any financial or other assistance, including, but not limited to, medical, health, dental, or disability benefits or insurance of any nature in the event of injury, illness, death, and/or damage to property. Further, as a Volunteer I agree to provide any and all medical history that may require medical treatment while traveling and engaging in activities as a New Hope Uganda Volunteer, particularly if emergency medical treatment may be required.

  • Please type full name to acknowledge that you have read and agree to the terms above.
  • If signed by Parent or Guardian of Volunteer Under Age 18