Assumption of Risk Form
for Short-Term Missions Volunteers
Washington Heights Baptist Church
Note: This form is for use by adult members who participate on short-term missions trips to other countries. Because Washington Heights Baptist Church may not have insurance to cover injuries or accidents that occur on such trips, and it has no means of adequately supervising foreign activities, we ask members who participate on such trips to assume all risks associated with the trip as a condition of their participation.
All reasonable precautions have been taken and no problems are expected. Nevertheless, individuals, rather than Washington Heights Baptist Church, are asked to assume their own risk for the trip.
I, ______________________ [name of volunteer], in consideration of my acceptance as a short-term volunteer on a mission trip sponsored by Washington Heights Baptist Church 1770 E 6200 S, Ogden UT 84405
to __________________________________ [destination of trip], represent and agree that:
1. I am a volunteer worker and not an employee of Washington Heights Baptist Church for the purpose of this mission trip.
2. I am aware of the hazards and risks to my person and property associated with serving in a mission’s capacity, such hazards and risks including, but not being limited to, death or injury by accident, disease, war, terrorist acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I accept my assignment with full awareness of these risks, and, subject to any insurance coverage’s that may be available to me from any source, and only with respect to my church and its agents, officers, directors, and employees, I voluntarily assume all risks of death, injury, and illness associated with such risks, and any damage to my personal property, and I release Washington Heights Baptist Church and its agents, officers, directors, and employees from any liability whatever arising as a result of death, injury, or illness that I may suffer as a result of participation in the missions project. I further recognize that such risks have always been associated with missionary service (2 Corinthians 11:23-28).
3. I attest and certify that I have no medical conditions that would prevent me from performing my duties.
4. I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration, and warrant that this commitment constitutes a legal, valid, and binding obligation upon me, enforceable against me in accordance with its terms.
5. I am aware of the hazards and risks to my person associated with participation in a short-term mission trip, as described above. I further understand that Washington Heights Baptist Church may not have insurance coverage that would apply in the event of my death, illness, injury, or damage to my property that may occur during my participation on the trip, and that if I desire insurance coverage I am responsible for the cost of such insurance.
6. I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING THIS RELEASE.
Date: _________________________________
Print Name: ___________________________
Signature: ______________________________
Address: ______________________________________________________________
Supplemental Application for Minor Children
Name of Minor: ______________________________________________________________
Project: ______________________________________________________________
Parents/Responsible Adult whom the minor will accompany: ______________________________________________________________
Policy on Participation of Minor Children
The participation of family members on mission projects is encouraged because it is a good formative experience, especially for young people. Non-medical/dental spouses and teenagers can make important contributions to our missions, but the key to their success is being able and willing to serve. Children should be mature enough to make a meaningful contribution and not distract their parents from their primary purpose and function. Children 14 and over usually fit in with the team by working independently of their parents as general helpers. There are also some mature 12 year olds who have performed well in the past. We leave the question of 12 and 13 year olds’ participation up to the discretion of their parents. In the latter case, the parent should attach a statement to this application which states that the child is mature enough to handle responsibility and delineating the tasks that he/she can perform. Everyone who attends a Washington Heights Baptist Church mission project must fulfill a specific function on the team in order to justify Washington Heights Baptist Church provision of a tax deduction for their expenses.
Policy on Minor children of Non-Participants
Adults who wish to take minor children who are not their own on a Washington Heights Baptist Church project must be able to prove their right to do so to the authorities in the host country. The responsible adult(s) must have the following in their possession at all times while on the project: 1) a written statement from both the minor’s parents or legal guardian stating that they place their minor child under the limited temporary custody of a particular adult mission participant (if only one parent signs, the statement must specify that the other parent is either deceased or does not have legal custody of the minor.); 2) a limited power of attorney (or clearly worded statement) authorizing the responsible adult to obtain whatever medical care may be necessary for the well-being of the minor. Both of these statements MUST be notarized and carry the appropriate seal. Failure to show a clear, unambiguous right to at least a limited form of temporary custody of a minor child in developing countries can result in serious legal problems, including the removal of the minor to local “protective” custody. While Washington Heights Baptist Church would do what it could to help under these circumstances, it cannot be responsible for the consequences. The best insurance against such problems is adequate preparation.
Agreement to Hold Harmless and Indemnify
I certify that I am the parent/legal guardian of , ______________________________________
A minor. Further, in consideration of the fact that the said minor child is being permitted to participate in this outreach project. I hereby agree that in the event that any claim for damages or injuries to said minor child or his/her property is ever made as a result of this outreach project, I will indemnify and hold harmless and make completely whole, Washington Heights Baptist Church, their affiliates, subsidiaries, officers, employees, and agents for any and all costs associated with said claim.
I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING THIS RELEASE.
Date: _________________________________
Print Name: ____________________________
Signature: _____________________________
Address: ________________________________________________________________
