(Release of Liability and Permission Regarding Medical Care)
THIS IS A RELEASE OF LIABILITY AND AN AUTHORIZATION REGARDING MEDICAL CARE. BY SIGNING BELOW, I AM AGREEING TO RELEASE WINE TO WATER AND OTHER PARTIES FROM LIABILITIY. I AM ALSO GRANTING PERMISSION TO WINE TO WATER, 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 trip is a privilege. In consideration for the privilege of participating in this trip, I am signing this Release and Liability and Permission Regarding Medical Care form (Release). I acknowledge that l am a competent person acting on my own free will and that participation in this trip may involve certain risks of physical injury, illness or death, including risks of which I may not presently be aware, and I hereby agree to assume such risks.
RELEASE AND INDEMNIFICATION//
I hereby agree to release and hold harmless Wine to Water, member of it’s Board of Directors and it’s officers, employees, members, volunteers, agents and sponsoring organizations and affiliates, members of it’s Board of Directors and it’s officers, employees, members, volunteers, agents (collectively, the Released Parties), from, and to discharge and waive any and all claims, demands, losses, damages, and liabilities described therein, whether known or unknown, foreseen or unforeseen, future or contingent based on an negligence by the Released Parties. PROVIDED, 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 and Released Parties from any and all claims, demands, losses, damages, and liabilities for indemnities, contribution or 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.
AUTHORIZATION OF MEDICAL CARE//
I attest and certify that there are no known medical conditions that would prevent me from participating. I understand and acknowledge that Wine to Water, together with the sponsoring organizations, provides foreign trip insurance coverage as a part of the cost of the trip. I understand and acknowledge that the provided coverage is not intended to take the place of a personal or group health insurance plan and may not specifically apply in every event of illness, injury, death, or damage to my property that may occur during participation on this trip.
In case I am in need of any necessary 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 Wine to Water, to consent to and authorize the administering 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 on my behalf made by Wine to Water or it’s authorized agents or employees. If I am a minor, I understand that efforts will be made to contact my parent/guardian before these actions are taken.
Wine to Water and I agree that should a claim or dispute arise from my participation in this trip, it shall be settled by legally binding mediation as set forth in the N.C. Mediation Act, Laws, or Statutes, as revised from time to time. The venue for such mediation or conciliation process shall be Boone, North Carolina, or such other location agreed upon by both parties. Judgment upon an arbitration award may be entered in any court having jurisdiction.
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, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns. The 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 eighteen (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 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. (Any personal or first person reference herein to a person waiving rights or agreeing to this waiver shall be interpreted to include parents signing such waiver for and on behalf of a minor.)
Photo and Video Release
I hereby give Wine to Water, its representatives and those acting under its authority, the absolute right and permission to use any media in which I am a participant, in whole or in part, which may be made or recorded for use by Wine to Water. The media shall be used at the sole discretion of Wine to Water and I waive any and all rights I may have to the media in connection with its use by Wine to Water, or the work in which it may be used. In the event such waiver should be ineffective for any reason, I hereby assign such rights to Wine to Water.
I release, discharge and agree to hold Wine to Water harmless from and against any and all liability in connection with the use of such media.
Cultural Sensitivity Statement and Contract
I acknowledge and understand that I will be working in a foreign country and that I will follow all instructions on appropriate behavior in the particular foreign country where I volunteer. This will include but not be limited to the use of alcohol, drugs, cigarettes, profanity, sexual comments, or a romantic relationship with anyone while on this trip.