MIMA Foundation, Inc.

 

Release Form

 

Release Provisions

 

1. Preliminary Statement: It is the goal of The MIMA Foundation to assist individuals who are interested in volunteer activities. The purpose of this Release is to relieve the MIMA Foundation from legal liability under the circumstances set forth in this document. The effect of this document, when signed, is to preclude you from asserting various legal rights which you may otherwise have in the absence of such an agreement. Please read the provisions carefully.

 

2. Negligence of the MIMA Foundation: In the consideration for the MIMA Foundation agreement to assist the Participant in the Participant’s volunteer medical activities, we hereby voluntarily release, waive, and forever discharge The MIMA Foundation, its operators, agents, employees, lessors, heirs, successors, and/or assigns from any and all claims, demands, damages, causes of action, cost, loss of service, expenses, and compensation on account of, or in any way growing out of, any injuries or harm to the Participant which may arise or occur as a result of the MIMA Foundation own negligence with respect to the Participant .

 

3. Assumption of the risk by the Participant: In consideration for the MIMA Foundations’ agreement to assist the Participant in the Participant’s volunteer activities, we hereby assume responsibility for the risks inherent in the participation of missionary activities, and expressly agree to voluntarily release, waive, and forever discharge the MIMA Foundation, it operators, agents, employees, lessors, heirs, successors, and/or assigns 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 the Participant, which may arise or occur as a result of the Participant’s activities and the resulting risks to which the Participant may be subjected.   We are aware these risks may include sickness, injury or loss of life due to exposure to sub-standard living conditions, injury or loss of life due to aggression or criminal acts of declared or undeclared war: injury or loss of life due to any violations of local or international law by the Participant; injury or loss of life due to contact with unleashed, untrained, or wild animals; and injury or loss of life due to Acts of God (such as lightning, floods, etc.)

 

4. Authority to approve medical treatment: We hereby place within the MIMA Foundation discretion the ability and power to authorize all medical care and treatment it reasonably believes necessary during the Participant’s involvement in volunteer activities, including but not limited to, emergency surgery and/or hospitalization. The Participant agrees to assume all responsibility for medical expenses which may be incurred by and on behalf of the Participant, and agree to reimburse the MIMA Foundation for all sums so expended.

 

5. Relationship between Participant and the MIMA Foundation: The Participant  understands that the MIMA Foundations’ function is to assist the Participant in engaging in volunteer activities. For this reason, the Participant understands that the MIMA Foundation does not serve in a fiduciary or parental capacity to the Participant, and that the MIMA Foundation does not accept, shall not be charged with, the rights, duties, and responsibilities of a fiduciary or parent, other than those which are expressly set forth in the Release. To the extent that the MIMA Foundation would otherwise bear these obligations, the Participant hereby voluntarily release, waive, and forever discharge the MIMA Foundation, it operators, agents, employees, lessors, heirs, successors, and/or assigns from any and all claims which may arise or accrue as a result of the fiduciary or parental responsibilities with which the MIMA Foundation might otherwise be charged. In this respect, we further release and discharge the MIMA Foundation from responsibility or liability in the event the Participant is taken hostage or kidnapped during the Participant’s involvement in volunteer activities the Participant hereby expressly releases the MIMA Foundation from any responsibility for making any payment described as ransom or otherwise, or meeting any demands and/or conditions described as ransom or otherwise in the event the Participant is taken hostage or kidnapped.

 

6. Indemnification agreement: In consideration for the MIMA Foundations’ agreement to assist the Participant in the Participant’s volunteer activities, the Participant hereby voluntarily agree to indemnify the MIMA Foundation and hold it harmless from any and all claims, demands, damages, causes of action, costs, loss of services, expenses, and compensation arising from any personal injury or loss of life suffered by the Participant. Moreover, the Participant herein expresses our intention to indemnify the MIMA Foundation for injuries or loss of life arising from, or occurring as a result of, certain specified types of conduct. The Participant hereby indemnifies the MIMA Foundation for injuries or loss of life suffered by the Participant as a result of the MIMA Foundations’ own negligence. We also hereby indemnify the MIMA Foundation for injuries or loss of life suffered by the Participant as a result of the negligent or intentional conduct of third parties, said third parties including, but not limited to, criminals, agents, operatives, or residents of foreign countries, and medical personnel who may be called upon to treat or attend to the Participant. Finally, the Participant herein indemnifies the MIMA Foundation for any and all claims not otherwise specified herein which may arise from the injury to, or loss of life by, the Participant.

 

7. Provisions to be read together: The provisions of this release, including the Preliminary Definitions, are to be construed together (in pari materia), so that this document shall be considered as a whole in the event a dispute regarding its language should arise.

 

8. Incorporation of definitions, construction: The Preliminary Definitions to this release are hereby incorporated in, and made an integral part of this release. In the event an ambiguity or disagreement arises regarding a defined term, the definition as set forth in the Preliminary Definitions shall control. In the event an ambiguity or disagreement arises regarding a term which is not defined in this release, it is the intention of the parties that the term or language at issue be accorded its plain meaning.

 

9. Law and jurisdiction to govern: This release shall be construed and enforced in accordance with the laws of the State of Florida, and the parties agree to submit themselves to the jurisdiction of the courts of Florida, which shall be the sole jurisdiction in which any parties may institute and maintain a legal proceeding against the other party arising from any dispute regarding this release. Venue shall be in Palm Beach County, Florida. In the event any party initiates a legal proceeding in a jurisdiction other than Florida, or initiates a legal proceeding in a venue other than Palm Beach County, Florida, the other party may assert as a complete defense, and as a basis for dismissal of such legal proceedings, that the legal proceeding was not initiated and maintained before a court of competent jurisdiction in Palm Beach County, Florida, in accordance with this paragraph.

 

10. Severability: In the event any specific term or provision is found invalid or unenforceable under the laws of Florida, that term or provision shall be stricken, but only so much as to excise the offending term or provision only. The remainder shall remain fully valid and enforceable, and shall be construed together (in pari materia) with the other provisions of this release.

 

11. Binding effect: This release shall inure to the benefit, and shall be binding upon the parties to this agreement. In addition, with respect to the Participant, this release shall be binding on his or her spouse, children, heirs, personal representative(s), successor(s), administrator(s), legal representative(s), and/or guardian(s). With respect to the parent(s) or guardian(s) executing this release together with the Participant, this release shall be binding on the parent(s) or guardian(s), spouse, children, personal representative(s), successor(s), administrator(s), legal representative(s), and/or guardian(s).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIMA Foundation, Inc.

 

Release Form

 

Executed on _______________, 20___, by and between MIMA Foundation, and _______________________, as the participant, and/or _____________________, as the parent(s) and/or legal guardian(s) of the participant.

 

Definitions

 

The terms defined on this page are printed in bold face wherever they appear in the Release. If you are unsure about the meaning of a defined term while you are reading this Release, please refer to the definition as set forth on this page.

 

The MIMA Foundation – Shall refer to and include MIMA Foundation, PO Box 7133 Jupiter, Florida 33468-7133 and its operators, agents, employees, lessors, successors, and/or assigns.

 

Participant – Shall refer to _________________________, who will actually be traveling and engaging in volunteer activities. The term “Participant” shall also include the Participant’s spouse, children, heirs, personal representative(s), successor(s), administrator(s), legal representative(s), and/or guardian(s).

 

 

We have read, understand and, by affixing our signatures hereto, signify our express agreement to each and every provision in the release.

 

 

__________________________

Participant

 

______________________________

Parent or Guardian

 

Sworn to and subscribed before me this ___________day of _____________, 20____.