The sole purpose of my visit is to assist the medical mission team to provide services to patients. I agree to abide by the PWH mission and standard of practice at all times. I agree to follow acceptable rules of conduct, best practices and the laws of the United States as well as those of the country I am travelling to on the medical mission . I do not intend to use my trip for any other purpose whether under the name of Partners in World Health or not. I will not provide or publish any information to the media or other publishing outlets without prior written permission from PWH. I further agree to abide by the confidentiality requirements put forth by partnering organizations.
I understand that this is a voluntary mission and I am fully responsible for the financial costs of my trip. PWH does not take any responsibility for any financial, legal, or health-related costs for my trip or after for any acquired damages. I agree that I am participating at my own risk, and neither I nor my family will bring legal action against PWH or any of its representatives should I become injured, become ill, lose work or die as a result of my participation in this mission.
I, have read, fully understand, and hereby agree to comply with the rules, regulations and requirements presented and explained within this form. I represent that I have the professional or other training necessary for me to adequately and safely fulfill my identified role on this mission, Further, I, for myself, my estate, my heir’s and successors, hereby covenant and agree to hold PWH, its officers, directors, members, agents and employees harmless and to indemnify them from any and all liability for injury, loss, claims or damages from any cause to person or property, including, without limitation, my own, arising out of my involvement in the mission, all actions and travel related to the mission and conduct in connection with the mission, regardless of negligence.