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General Release Form
ISMS (Rev. 3/11/08)
In consideration of International Surgical Mission Support, Inc. (ISMS) arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representatives, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE ISMS, its officers, directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my services as a volunteer with ISMS whether caused by the negligence of ISMS or otherwise. This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss, or cost.
In making the General Release set forth herein, I understand that as a volunteer on a medical or surgical mission organized by ISMS, I may travel to areas of the world with sub-standard living conditions which may contribute to sickness, injury or loss of life. I also understand that the circumstances in the countries to which I may travel may increase the risk to me of criminal acts by third parties, including kidnapping or assault and war or armed aggression. In the case of illness or injury, I also authorize ISMS to arrange for medical care and treatment, including emergency surgery or hospitalization, at my cost and expense.
I hereby represent to ISMS that I know of no illness or other medical condition of my own that could interfere with my ability to undertake the volunteer assignments contemplated herein. If I become aware of any such illness or other medical condition I will inform ISMS before undertaking a volunteer assignment.
I understand and agree that it is my responsibility to identify and obtain the required or appropriate visas, immunizations, vaccinations and medications for the countries to be visited during any medical or surgical mission in which I participate.
This document shall be construed under the laws of the state of New York. If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is construed against the party preparing such document shall specifically not be applicable to the interpretation of this document.
This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representation, or promises. All of the terms hereof are contractual and not mere recitals. Any determination that a provision hereof is invalid or unenforceable shall not affect the remaining provisions hereof which shall continue in full force and effect.
I acknowledge that I have carefully read this General Release, know and understand the contents thereof, and that this document was freely and voluntarily executed. I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters herein before I signed this General Release.