HHPF SERVICE-LEARNING TRIP PARTICIPATION AGREEMENT & LIABILITY RELEASE
1. I am applying for and intend to participate in a trip sponsored by the Hackett Hemwall Patterson Foundation (HHPF).
2. I desire to travel under the auspices of the HHPF for the purpose of working with the organization and entities in the designated country to improve the health of the local people. I understand and agree that the HHPF is not acting as my agent in any regard, except as explained below; that the HHPF will make every effort to assist me in providing this service, but is not liable for any travel delays or safety issues while participating in this trip. I am responsible for securing my own identification and health documentation. I will work to the best of my ability within the scope of my license and training on the project designated by the HHPF.
3. I understand and am aware that my participation on this trip may expose me to certain risks and dangers, including but not limited to, the hazards of travel by various means of conveyance; the hazards of politically unstable areas; the dangers of civil disturbances and war; the forces of nature; acts or omissions of the HHPF and/or their respective agents, officers, or directors, and accidents or illness in places without access to medical facilities, transportation, and/or means of rapid evacuation or assistance. I understand that I am responsible to obtain my own insurance to cover medical care outside of the United States (or my home country). This coverage should include medical evacuation provisions.
4. I am aware that my participation on this trip and my use of transportation, housing and dining services, and other goods and services in connection with my participation on this trip carries a risk of personal injury, serious illness, death and property damage or loss. I expressly and voluntarily assume all risk of the injury, illness, death and property damage or loss that may result from my participation on the trip and/or my use of goods and services in connection with my participation on the trip.
5. In consideration for being permitted to participate on the trip, I hereby RELEASE AND DISCHARGE THE HACKETT HEMWALL PATTERSON FOUNDATION and its respective agents, officers, directors and associates (“the Released Parties”) from any and all liability for injury, illness, death, property damage or loss arising out of any other activity incident to my participation on this trip.
6. I agree not to sue or make claims against the Released Parties for injury, illness, death, damage or loss sustained as a result of participation on this trip or the use of the goods and services in connection with my participation on this trip. I will indemnify and hold harmless the Released Parties from all claims, judgments, and costs, including attorney’s fees, incurred in connection with any action relating to my participation on this trip.
7. I understand that the Hackett Hemwall Patterson Foundation may notify the person or persons listed as an emergency contact on this form in the event that I become seriously ill or am involved in an emergency situation during the trip. In the event that I am unable to make my own medical decisions, a representative of the Hackett Hemwall Foundation may have to make those decisions on my behalf.
8. Should any of the provisions of this Agreement and Release, or portions thereof, be found to be invalid by any court of competent jurisdiction, the remainder of this Agreement and Release shall nonetheless remain in full force and effect. The Agreement and Release shall be construed under the laws of the State of Wisconsin.I HAVE CAREFULLY READ THIS LIABILITY AGREEMENT AND RELEASE.I FULLY UNDERSTAND ITS CONTENTS. MY SIGNATURE ON THIS APPLICATION INDICATES MY CONSENT AND ACCEPTANCE OF THE CONDITIONS STATED ABOVE AND CONSTITUTES A VALID LEGAL SIGNATURE. I SIGN IT OF MY OWN FREE WILL.IF I am the parent or guardian of a minor who is applying for this trip, I understand that I am accepting legal responsibility for completing this application by signing the Agreement and Release of Liability on behalf of the minor.