ASSUMPTION OF RISK AND INSURANCE ELECTION


Blessman International, Inc

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:

  1. I am a volunteer worker and acknowledge that I am not an employee of Blessman International, Inc.
  2. I am aware of the hazards and risks to my person and property associated with serving in a missions capacity, such hazards and risks including, but not being limited to, death or injury by accident, disease, war, terrorist’s acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I accept my assignment with full awareness of these risks, and, subject to the insurance coverages described below, I voluntarily assume all risks of death, injury, illness, and damage to myself or any member of my family associated with such risks, and any damage to my personal property. I further recognize that such risks have always been associated with missionary service (2 Corinthians 11:23-28).
  3. I attest and certify that I have no medical conditions that would prevent me from performing my duties.
  4. Subject to insurance coverages described below, I waive and release any and all claims for damages which I, or my heirs or successors, may have against Blessman International, Inc. or the local church sponsoring the trip, or any agent or employee of any of such organizations, arising from my death, injury, or illness, or any property damage or loss occurring during the term of my assignment or as a result of my assignment.
  5. In the event that I have minor children who will accompany me on my assignment, I, acting both on my own behalf and in their behalf as their parent and legal guardian, and subject to the insurance coverages described below, do hereby assume all risks of death, illness, or injury that they may suffer as a result of said assignment, from those causes described above.
  6. I understand and accept the following policy of Blessman International, Inc. regarding ransom payments:
    Blessman International, Inc. has determined that it will not pay ransom nor yield to the demands of anyone who takes one of our missionary family or staff hostage. Blessman International, Inc. pledges itself to every effort in prayer and all other appropriate means to obtain the release of one taken hostage should it ever occur. This policy was made after sufficient study of the policies of other evangelical missionary societies and after considering the advice of the United States’ State Department.
  7. I expressly waive any defense to the enforcement of any provisions of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms.
  8. I expressly agree that this assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT.

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.

SIGNATURES

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:

Blessman International https://blessmaninternational.org
Signature Certificate
Document name: ASSUMPTION OF RISK AND INSURANCE ELECTION
Unique Document ID: ade61e8659a0da24fd7d0bc562f78594cf98b719
Timestamp Audit
December 6, 2017 3:23 pm GMTASSUMPTION OF RISK AND INSURANCE ELECTION Uploaded by webdev BlessmanInternational - [email protected] IP 175.158.216.213