Remote Area Medical Philippines thanks you for volunteering. Each volunteer is required to read and sign the Volunteer Agreement and Liability Waiver as a condition of participating in the event.
CONFIDENTIALITY STATEMENT
I understand that while I am participating as a registered volunteer 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:
I understand that any travel involves danger and risk. I acknowledge that the dangers and risk include, but are not limited to, the hazards of travel; risk of death; sickness or injury in areas where medical assistance may be limited or inadequate, unavailable or not readily available, and/or were rapid evacuation is not available; or where there is exposure to crime, to civil unrest and to forces of nature or other dangers.
I attest and certify that I am physically fit and have no medical conditions that would prevent me from performing my assigned duties which may include long hikes, extreme heat/cold, limited and infrequent meals. I am aware of the disease risks associated with travels and I accept these risks.
I understand that while traveling, I will be subject to the laws, rules, and law enforcement of the local government unit in which I am visiting. Any violation of such laws could result in my being detained or otherwise involved with local law enforcement authorities and beyond the control of RAM Philippines' supervisors.
I understand that if my conduct during or outside of required program activities presents a hazard to other people on the trip, the program administrators reserve the right to take appropriate action to protect the mission program and its administrators and participants from further disruption of the activities or risks of physical injury, including action to terminate the right to participate in the program.
I understand that Remote Area Medical Philippines does not or may not carry any insurance relative to the trip or for injuries to the volunteer.
If any emergency medical procedures or treatments are required during the trip, I consent to the trip supervisor(s) as identified by RAM taking, arranging for, and consenting to the procedures or treatment in supervisor's discretion. I will pay for the costs of any such medical procedures or treatment.
If there is any dispute arising from or involving this Agreement, I agree that the dispute shall be governed by the Philippine law, without regard to conflict of law provisions.
I hereby grant the Remote Area Medical permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
I understand and agree that all photos will become the property of the Remote Area Medical and will not be returned.
I hereby irrevocably authorize Remote Area Medical to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge Remote Area Medical from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
If this Agreement is breached, I agree that RAM shall be entitled to all costs associated with enforcement of the Agreement including, but not limited to, attorney fees incurred.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.
