My Account

"*" indicates required fields

Release of Liability

Note: One form is required for each participant
It is my desire to serve the Lord with South America Mission (SAM) and in consideration of the training and other benefits provided to me by SAM, the receipt and sufficiency of which is hereby acknowledged, I enter into this Release of Liability on the following terms and conditions.
(participant name) hereby certify that I am willing, physically fit and will be sufficiently prepared to travel with and participate in the activities expected of me. I have consulted government recommendations and considered myself appropriately immunized for travel. I understand that there are many risks which might accompany such travel and activities, many of which are not normally experienced in North America, and I have made my decision to participate in this capacity only after a reasonable, independent inquiry into all matters of concern to me. I understand that Latin America is a highly diverse region and that I may travel to and/or live in a very primitive area, and that the risks inherent thereto include, but are not limited to: the risk of civil or political unrest, war, terrorism, and crime; arbitrary detention or imprisonment by political, military, or revolutionary groups or authorities; exposure to food and water-borne disease and to disease from other agents or sources, known or unknown; lessened regulatory and private standards in matters of health, safety, welfare, and property rights; kidnapping; travel-related incidents; and other risks not specifically listed above.
I also accept the risk of personal injury, death or property damage, loss or destruction, which might attend the activities that I undertake with SAM. I grant my permission for SAM or its designee to take me to a doctor for medical treatment, including hospitalization or emergency surgery if the need should arise, and I assume the responsibility for all medical bills resulting from such treatment. I understand that the medical facilities and personnel available and the standard of care supplied may not be of the quality generally available in North America.
Having acknowledged and accepted these risks, on behalf of myself and my spouse, children, heirs, personal representative(s), successor(s), administrator(s), legal representative(s), and/or guardian(s) (i) I expressly and voluntarily do hereby release, waive, and forever discharge SAM, its operators, directors, officers, agents, employees, lessors, heirs, successors, and/or assigns (the “SAM Released Parties”) from any and all claims, demands, damages, causes of action, costs, loss of services, expenses, and compensation on account of, or in any way growing out of, any injuries or harm to me or my property, which may arise or occur as a result of these activities and the resulting risks; and (ii) I hereby agree to hold the SAM Released Parties harmless from any damages resulting from my activities with SAM, and agree to proactively defend and indemnify and reimburse the SAM Released Parties for any such damages.
I agree that if any part of this Release is deemed to be invalid or unenforceable, the remaining portions will continue in full force and effect. I acknowledge that I am not relying upon any representations made to me by SAM, or any of its representatives, relating to my travel and participation in these activities. I acknowledge all of the foregoing risks and any other risks which might be incidental to such activities with SAM and hereby accept those risks of my own free will. I assert that I have read and fully understand this Release of Liability, and hereby sign voluntarily and without duress or coercion of any sort.
MM slash DD slash YYYY
(month, day, year)
(Participant Name)