Mission Liability Waiver and Medical Release

NOTICE: This is a binding legal document. Please read carefully and sign. Consult an attorney if you have
any questions. It is a release of claims and hold harmless for future accidental injuries or death of the
participant and all of his or her family members. It is also an authorization for emergency medical or
dental care for the participant.

1. I have inquired about the activity to my satisfaction and am aware of all the inherent dangers and
   hazards of the above activity/event and the benefits to be gained by myself, the participant, engaging in
   the activity/event.
   
   
2. By signing this form, I understand and agree that neither Buffalo Dream Center, hereinafter known as
   BDC, nor its agents, officers, directors, employees, volunteers, or ministry partners may be held liable in
   any way for any occurrence in connection with the above activity/event which may result in illness,
   injury, death, or other dangers to myself, the participant, or my heirs, family members, or assigns. I
   waive any such claim for compensation, liability, or reimbursement of any incurred expenses as a result
   of illness, injury, death or other medical expenses.
   
   
3. By signing this form, I understand and agree that neither the BDC, nor its agents, officers, directors,
   employees, volunteers, or ministry partners may be held liable in any way for any lost, stolen, or
   damaged property belonging to myself, the participant, or my heirs, family members, or assigns. I waive
   any such claim for compensation, liability, or reimbursement of incurred expenses.
   
   
4. For being allowed to participate in the above activity/event, myself, the participant and all my family
   members, heirs, or assigns personally assume all risks in connection with the activity. I release BDC, its
   agents, officers, directors, employees, volunteers, or ministry partners from any injury or damage, which
   may befall me while engaged in the above activity/event. This release includes all risks connected with
   the activity/event, whether foreseen or unforeseen. I further agree to save and hold harmless BDC and
   the named persons from any claim by me, or family members, estate, heirs, or assigns arising out
   of the participation in the above activity/event.
   
   
5. I authorize any ambulance or hospital emergency service that may be rendered necessary to myself,
   the participant. I understand that I, the participant, assumes responsibility for the payment of the
   ambulance, doctor, dentist, or hospital fees. I waive any such claim for compensation, liability, or
   reimbursement of incurred expenses.
   
   
6. By signing this waiver, I understand that in the event I, the participant, is sent home or has to leave
   early from the activity/event listed above, I assume all expenses related to and necessary for the early
   departure such as but not limited to car rental, transportation expenses, gas expenses, lodging, meals,
   and airfare. I waive any such claim for compensation or reimbursement of such expenses.
   
   
7. Further I give my permission for any and all pictures, audio, videos, or personal testimonies to be used
   in part or in whole in any and all future publications printed or recorded, (audio or video), without prior
   notification or royalties by the Buffalo Dream Center
   
   
8. Furthermore, I state that I, the participant, am at least 18 years of age and am legally competent to
   sign this agreement and release; I understand the terms in this agreement and release are contractual
   and not a mere recital; I have fully informed myself of this agreement and release by reading it before I
   signed it; I have had the opportunity to consult with legal counsel regarding the effect of this agreement
   and release, should I so desire; and I have signed this document of my own free act.

Applicant Name *

First

Last

Wish to voluntarily participate in the activity/event described in this form. *

Dates/time frame of trip(s) *

Agreement *

• I have read and agree to the terms of this liability waiver and medical release for the above stated missions trip.

Dated this *

of *

in the year *

Full Legal Name *

First

Middle

Last

Signature (type name) *

Typing your name here is equivalent to signing in person and will be held as such.

Submit