Medical and Liability Release Form 2018

Transcription

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2 Please Print Clearly Medical and Liability Release Form 2018 Name: Today s Date: Birthday: Age: Current Grade: Address: City: State: Zip Code: Parent/Guardian: Phone: Parent Emergency Contact: Relationship to Participant: Contact Phone 1: Contact Phone 2: Health Insurance Company: Policy Number: Insurance Co. Phone Number: Allergies: In consideration for being accepted by Riverlawn Christian Church (RCC) for participation in all activities for the year of 2018, I, being 21 years of age or older, do for myself hereby release, forever discharge and agree to hold harmless Riverlawn Christian Church and the directors thereof from any and all liability, claims, or demand for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participation in any activity or trip for the year of I also give authorization for my child s photo(s) to be used in print and electronic publications as pertains to RCC. Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. I further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for any liability sustained by said church as the result of the negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto. I am the parent or legal guardian of this participant, and hereby grant my permission for him/her to participate fully in all activities. I understand that every effort will be made to contact me prior to the administering of any medical treatment and hereby give my permission to take said participant to a doctor of hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I hereby assume all transportation costs. Parents/Guardians, please read and discuss the following with your student or child: On all of our events, we have certain expectations regarding behavior which will insure that we all have a great experience. If, during this event, you are unwilling to maintain these expectations, please understand that you will be sent home and/or (if under 18) parents will be notified. Please sign below indicating that you understand this and agree to cooperate. Participant Signature: Date: Parent/Guardian Signature (if under 18): Date:

3 MEDICAL RELEASE FORM Adults (Age 18 and up) Minors (Age 0-17) Medical Information (Everyone) o PO Box , El Paso, TX questions@casasporcristo.org casasporcristo.org

4 Disclousre of Risk 6.17 DISCLOUSRE OF RISK, AGREEMENT OF WAIVER, RELEASE AND HOLD HARMLESS Team Name Date of trip I, First and last name Date of birth of Street address City, state, zip hereby agree and acknowledge: 1. I understand that any travel, volunteer work, or other activities I undertake in connection with Casas por Cristo involves inherent risks to my property, health, and life and I further understand the nature of such risks. 2. I grant Casas por Cristo, its representatives, and employees permission to take photos and videos of me and my property in connection with my mission trip. I authorize Casas por Cristo to use my likeness for any lawful purpose across all types of media, including publications, advertisements, Web content, promotional content, etc. 3. No principal, officer, agent, employee, or other person associated with or acting on behalf of Casas por Cristo has disavowed or contradicted anything in this document, including the statements regarding the existence and nature of the risks involved. 4. The undersigned recognizes and acknowledges that Casas por Cristo is a charitable, non-profit corporation engaged in human services and relief activities. The undersigned, for himself/herself, and members of this team, does hereby freely and knowingly waive any and all actions, causes of actions, claims, and demands for or by reason of loss of life, bodily injury loss, including, but not limited to the contraction of any endemic diseases, costs, damage, or expense for any act, or omission on the part of a third party upon the part of Casas por Cristo or any of its officers, agents, servants, or employees for anything in any way arising from or connected with, either directly or indirectly, any volunteer activities of the undersigned volunteer or of Casas por Cristo. The undersigned realizes that activities which he/she intends to pursue may entail some amount of risk or possible danger and desires to personally assume such risks. 5. This agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas. This agreement is to be governed by the laws of the state of Texas. If any portion of this agreement is held invalid, it is agreed that the remainder shall nevertheless continue in full force and effect. 6. I enter into this agreement freely and voluntarily in consideration of the permission to participate in the activities described herein and of the benefits associated with such activities. I understand that this agreement is contractual and binding upon me. 7. I have read this document and understood and agreed to all of its contents before signing it. For up-to-date information about travel outside the U.S.A., please visit or call Signature Date Parent or guardian signature Date Print parent or guardian name City and state where signed Please fill out and give to your team leader to be scanned and ed to questions@casasporcristo.org

5 Acuña Trip Guide

6 QUICK GUIDE PACKING LIST 3-6 Months Prior to Your Trip 30 Days Prior to Your Trip

7 TABLE OF CONTENTS

8 TRIP PREPARATIONS Immunizations & First Aid Time Zones Emergency Contact Number Transportation & Luggage Passports Medical Treatment Devotions Cell Phones Support Money

9 Weather 30 DAYS PRIOR Disclosure of Risk Medical Release MÉXICO GUIDELINES Travel Insurance Attire

10 DO NOT PACK GIFTS FOR THE FAMILY Note: Your Casas Missionary ARRIVAL

11 Follow Your Casas Missionary Closely U.S. Border Customs Spanish Items Not Allowed Meeting Up With Your Casas Missionary Don't Drive After Dark DRIVING IN MÉXICO Crossing Into México Mexican Police Cars

12 MÉXICO LODGING Preparedness Work Site Bathroom Showers Animals Bathrooms Stay in a Group Personal Belongings Sleeping Attitude WORK SITE The Recipient Family

13 Fall, Winter, and Spring Building Schedule WORK SITE SAFETY Tools Summer Building Schedule Concrete Trucks

14 Construction Process OTHER Casas por Cristo Merchandise What Just Happened? Timeline

15 Copyright 2018 Additional Ministry Opportunities