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International Travel Liability Release Form

By submitting this form I am stating that I understand:

Participating in a mission’s trip to Honduras is elective and that I could encounter health and / or safety risks as a result of that decision.
It is my responsibility to assess all risks associated with traveling to Honduras and that I am at liberty to change my mind about participating at any time before departure. I affirm that I have completed that assessment and have decided to participate in this mission trip.
It is my responsibility to maintain a current knowledge of travel advisories, medical advisories or other risks until my departure and while I am on location.
It is my responsibility to notify the team leadership if I learn of anything that would alter the risks to others or myself at any time.
The team leaders, individuals in our group, or the staff in Honduras may not be able to intervene or rescue me if I become involved in acts of crime or violence.
Medical care and medical facilities might not be readily available and that they probably will not meet the standards expected in the United States. To the best of my knowledge my health is good enough to undertake the trip. If I have any question about my health, I will visit my physician and discuss this trip before I go. I understand that I will be traveling to places where little to no health care will be available. In addition, I understand that I may undergo types of exertion that I am not used to.
I understand that medical trip insurance (including emergency evacuation coverage is required and that I can obtain it at either ( or (, or from any other reputable source of my choosing.
I agree to…

Act in a responsible way while in Honduras and to follow the directions of the leadership to minimize risks to myself and other members of the team.
Release and hold harmless the mission and all officers, agents and staff of the mission organizations for any and all claims and costs due to any liability, injury or damage which might occur as a result of my international experience, associated travel and living arrangement.
Because it could be in my best interests, I agree to allow the team leadership to release personal information about me to the US State Department or other agencies if they believe that it would be in my best interest.

My name here serves as my electronic signature that I have read the above document and agree to its terms and conditions.