I understand that while I am participating as a registered volunteeer at the Remote Area Medical Philippines clinic, it is mandatory that I maintain complete privacy and confidentiality of all patients. This pertains to all present and future written and verbal communications referring to any Remote Area Medical Philippines clinic patient. With my signature on the line below, I acknowledge that I have read, understood, and agree to adhere to this policy of confidentiality for the Remote Area Medical Philippines clinic.
RELEASE AND INDEMNIFICATION
I hereby release and indemnify Remote Area Medical Philippines, a non-profit organization, and all its respective officers, directors, agents, contractors, employees, heirs, successors and assigns from prosecution or presentation of any claim for bodily injury or death or for property loss or damage incurred in connection with Remote Area Medical Philippines expeditions or related activities. I fully understand that I am volunteering at my own risk and that due to my occupational/other possible exposure to blood or other potential infectious materials, I may be at risk of acquiring, Hepatitis B virus (HBV) infection, Human Immunodeficiency Virus (HIV) infection, or other blood borne pathogens. I understand if I do not have the HBV vaccine, I continue to be at risk of acquiring HBV, a serious disease. If, in the future, I want to be vaccinated with HBV vaccine, I can acquire the vaccination at my own expense.
ASSUMPTION OF RISK, RELEASE AND HOLD HARMLESS AGREEMENTS AND CONDITIONS OF PARTICIPATION
This is a legal document, which includes a release of liability. Read it carefully before signing.
In consideration of my being accepted by Remote Area Medical Philippines for participation in a medical relief trip, I make the representation and undertakings set out below:
IN CONSIDERATION OF AND AS PART PAYMENT FOR THE OPPORTUNITY TO PARTICIPATE IN THIS MISSION PROGRAM, I HAVE AND DO HEREBY ASSUME THE RISK OF, AND WILL HOLD HARMLESS REMOTE AREA MEDICAL PHILIPPINES AND ALL ITS OFFICERS, EMPLOYEES AND AGENTS, FROM ANY AND ALL LIABILITY, ACTIONS, CAUSES OF ACTIONS, DEBTS, CLAIMS AND DEMANDS OF EVERY KIND AND NATURE WHATSOEVER, AND SPECIFICALLY INCLUDING ANY CLAIM FOR NEGLIGENCE OR NEGLIGENT ACTS, WHICH I NOW HAVE OR WHICH MAY ARISE OUT OF OR IN CONNECTION WITH MY TRIP OR PARTICIPATION IN THIS ACTIVITY. THE TERMS HEREOF SHALL SERVE AS RELEASE, INDEMNIFICATION, AND ASSUMPTION OF RISK FROM HEIRS, EXECUTORS, AND ADMINISTRATORS AND FOR ALL MEMEBERS OF MY FAMILY, INCLUDING ANY MINORS ACCOMPANYING ME.
Prior to signing this document, I have had an adequate opportunity to read and understand it, have had an opportunity to ask questions about it, and any questions I have had been answered to my satisfaction.
I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS
OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS.