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HOLD HARMLESS. WAIVER OF LIABILITY.

AND EMERGENCY MEDICAL CARE AUTHORIZATION    

The Presbyterian Church (U.S.A.)  The Ethiopian Partnership of the Shenandoah Presbytery  is sponsoring [trip name] on [dates] (hereafter [trip name] on [dates] (hereinafter referred to as the "Program").  I, [participant name} of [address] in consideration of the opportunity to participate in the Program, and in consideration of other obligations incurred, hereby agree as follows:

1.   I fully understand that I may be traveling or staying in areas of the world which may have unstable

political, economic and security situations where acts of war, potential danger from lack of control over local population, terrorism or violence could occur at any time.
 

2. I fully understand that I may encounter difficult climates and living conditions; that risks are present concerning means of travel, food, water, diseases, pests and poor sanitation and other health related situations. Medical or emergency medical treatment may be inadequate or not available.
 

3.  I accept and assume all responsibility for my personal actions and any and all risks of property

damage   or personal injury which occur during or result from my participation, including potential injury while working.
 

4.  With the above in mind, I fully understand and agree that the Presbyterian Church (U.S.A.), the

General   Assembly, all of its entities, Presbyterian Church (U.S.A.), A Corporation, the Sponsor, their staff members, successors, assigns, officers, agents, representatives, ministry divisions, and entities (hereinafter referred   to as "PCUSA") shall not be responsible or liable in any way for any accident, loss, death, injury or damage   to myself or my property, in connection with the Program or any portion of the Program even if said injury or action is due to the alleged negligence of PCUSA. Further, I do hereby agree to indemnify and hold PCUSA   harmless against and from any and all liabilities, damages, claims, suits, judgments and associated costs and expenses (including, without limitation, reasonable attorneys' fees) of whatsoever kind in connection with the  Program or any portion of the Program. Further, I make this agreement on behalf of my heirs, agents, fiduciaries, successors and assigns. I waive, knowingly and voluntarily, each and every claim or right of

action I   have now or may have in the future against the PCUSA related to the Program, even if any such claim or right  of action is caused by PCUSA's alleged negligence.
 

5.  I hereby state that I am in good health and have all medications necessary to treat any allergic or

chronic   conditions, and I am able to administer such medications without assistance. If at any time during the Program  I need emergency medical care and am not able to give consent because of my physical or mental condition, I authorize emergency medical care decisions to be made on my behalf, and I specifically release PCUSA,  in making those emergency medical care decisions, from any and all liability associated with said decisions, even if injury or death is the result of PCUSA's alleged negligence.

6. This document does not release the PCUSA from gross negligence. 

7.  I HAVE READ CAREFULLY, AGREE TO, AND INTEND TO BE LEGALLY BOUND BY ALL TERMS OF THIS HOLD HARMLESS, WAIVER OF LIABILITY, AND EMERGENCY MEDICAL CARE AUTHORIZATION.

Signature                                                    Date

Witness

Printed Name 
                                                                      
Signature of Parent or Guardian is                                                                           also required if participant is under 18
 years of age.

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