I hereby release VOSH-Connecticut, its mission leaders,
officers and other designated personnel from the
responsibility for any accident, injury, sickness or death
to me or any member of my family, and/or loss or damage to
any material items occurring before, during, after or as a
result of the mission of January 2010 to San Juan del
Sur, Nicaragua.
I further authorize VOSH-Connecticut and its designees
to take and release any pictures or stories about my
participation in the mission to any VOSH-Connecticut related
publication and/or any news, radio, TV, website or other
media.
I further understand that should it be necessary for
me to cancel out of the mission for any reason, there is no
refund of airfare and any other related charges, costs, fees
and assessments, including the VOSH-CT mission member fee in
the amount of $135.00 which I agree to pay in full prior to
the start of the mission. These are all my responsibility
and I understand and agree that VOSH-Connecticut and its
mission leaders will not be responsible in any way for the
refund of said monies.
I hereby state that I am over the age of 18 and
qualified and of legal age and authority to sign this
release.
I have read and agree with the terms set forth herein,
and I am signing this release and participating in the
mission voluntarily of my own free act and deed with no
expectation of reimbursement or remuneration of any kind.
I further state and understand that I
have read the mission protocol in full and agree to comply
with all terms & conditions as set forth in the mission
protocol statement.