ASSUMPTION OF RISK AND INSURANCE ELECTION
Directions: Every trip participant must fill out this form and return it to Blessman International, Inc. before their departure. The cost of this insurance is included in the fixed cost of your trip. Please note that this form will not be considered complete without the signatures of two witnesses as specified on the back. More detailed information about the insurance plan is available at www.volunteercard.com. Please call us if you have questions.
PART1-Assumption of Risk
I, (name of volunteer), in consideration of my acceptance as a short-term volunteer with Blessman International, Inc. represent and agree that:
PART 2-INSURANCE ELECTION
I am aware of the hazards and risks to my person associated with serving in a missions capacity, as described above. I further understand that both Blessman International, Inc. currently requires the insurance coverage summarized below, that these coverages are subject to change, and that I am responsible for obtaining any additional insurance coverages that I consider necessary:
$25,000 Accident Medical Expense
$25,000 Sickness Medical Expense
$300,000 medical evacuation maximum
$25,000 repatriation of remains maximum
Please acknowledge by checking the box below:
I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I ACCEPT AND AGREE TO ALL OF ITS TERMS AND CONDITIONS. I ENTER INTO THIS AGREEMENT VOLUNTARILY, WITH FULL KNOWLEDGE OF ITS EFFECT.
IMPORTANT: Please have two (2) witnesses observe your signing of this form, and have the witnesses sign the space provided for them. They must be at least 18 years old, and they cannot be your relatives.
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: ASSUMPTION OF RISK AND INSURANCE ELECTION
Agree & Sign