About CCH + Documents: Liability Release
Mission Volunteer Waiver and Release Agreement
I, __________________________, have volunteered to serve on a mission to Pignon, Haiti, organized by the Community Coalition for Haiti, a non-profit organization dedicated to assisting the Comite de Bienfaisance de Pignon in improving medical care, public health, economic and educational opportunities in Pignon.
I understand that Haiti is one of the least developed and least stable countries in the Western Hemisphere and that it lacks most of the public health and public safety resources of the United States and other Caribbean countries. I understand that travel to Haiti involves a number of risks, including the risk of violence, serious injury, illness or death. Prior to signing this Waiver and Release Agreement, I have reviewed and understand the most recent version of the United States Department of State’s Consular Information Sheet regarding Haiti and any Travel Warnings issued for Haiti (available at www.travel.state.gov). I have also reviewed and understand the Center for Disease Control’s Health Information for Travelers to the Caribbean (available at www.cdc.gov/travel). These documents fully describe the risks associated with travel in Haiti.
I understand that the Community Coalition for Haiti cannot ensure or guarantee my health or safety. I hereby assume all risks associated in any way with my voluntary participation in the mission to Pignon, Haiti.
I hereby release, indemnify and hold harmless the Community Coalition for Haiti and its officers, directors, employees, and agents from any and all damages, claims, actions, liability and expenses (including costs of judgments, settlements, court costs, and attorney’s fees), regardless of the outcome of such claims or actions, arising out of or relating in any way to my participation in the mission to Pignon, Haiti. This Release shall bind me and my heirs, successors, legal representatives and assigns and inure to the benefit of the Community Coalition for Haiti, its officers, directors, employees and agents and their respective successors and assigns.
I have read and understand this Waiver and Release Agreement and have signed this voluntarily.
Signature: ________________________________
Print Name: _______________________________ Date:_____________________
Insurance Beneficiary: ____________________________________________________
Travel Insurance is provided to each participant by Adams & Associates International, www.aaintl.com.