Release Form

BHC’14 – location, dates to be set

Release of Liability and Release to Obtain Medical Care
for Lovelace/Lifework Forum, Inc.

Lovelace, Wuchterlova 343/1, 160 00 Praha 6, Czech Republic
email: info@LifeworkForum.org       skype: on request

Matthew 18:15-20 and 1 Corinthians 6:1-8 instruct us to live at peace and to resolve disputes in private or within the Christian church. I acknowledge my concern that the limited charitable resources of Lifework Forum, Inc. should not be dissipated on wasteful litigation. Therefore I expressly waive my right to file a lawsuit in any civil court or other secular setting against Lovelace/Lifework Forum, Inc. and other organizations and all individuals involved with this outreach.

I hereby release all leaders and organizations involved with this mission trip from any and all legal liability. I hereby waive all my rights to any legal liability, on the part of Lovelace/Lifework Forum, Inc. or any other individuals or organizations involved, which liability may result from sickness, injury, or death that may occur on or related to this trip. I fully realize that there are hazards, and I am fully assuming these risks, including but not limited to, hazardous traffic, poorly constructed roads, dangers resulting from military or political problems, acts of terrorism, sickness, and disease. I specifically release Lovelace/Lifework Forum, Inc. and all concerned from any claim of negligence in their duties as leaders, or otherwise, on this mission trip.

I hereby further acknowledge my responsibility to provide my own insurance coverage of any and all types, including but not limited to, medical, hospitalization, life, disability, death, lost baggage, lost or stolen personal property, and any and all other insurance which I may need or desire. I also hereby release Lifework Forum, Inc. and all leaders and organizations involved with this outreach from responsibility to provide insurance coverage of any and all types. I hereby further authorize the leadership of Lovelace/Lifework Forum, Inc. to make essential decisions on my behalf with respect to medical treatment, emergency surgery, or hospitalization, should such be necessary. However, Lovelace/Lifework Forum, Inc. shall in no way be responsible or liable for payment of any and all bills for such medical treatment. I assume the full responsibility for any and all medical bills incurred related to this outreach. My estate and my family shall further assume full and total cost for the return shipping of my body should I die by any cause on this mission trip.

I further agree wholeheartedly to abide by decisions made by leaders and those in authority.

I have read and am in full agreement with this release and waiver, and fully understand that I am waiving any rights I may have to litigate and sue and accepting full responsibility for all insurance and all medical costs; authorizing Lovelace/Lifework Forum, Inc. to make medical decisions if necessary and agreeing to read and abide by all guidelines, policies, rules, and leadership decisions pertaining to this outreach.

Date ____________________ Signature ________________________________________
(applicant)

Parent or Legal Guardian ________________________________________ (please print)

Signature of Parent or Guardian ________________________________________
(for applicants 17 yrs. or younger)