2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA

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Kory Flynn
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1 2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA Name of Participant : 2015 Mission Trip to (Location and Approximate Date of Trip): As a Participant in the 2015 Mission Trip I agree to the following: 1. Representations I agree to provide this Waiver / Release Agreement in exchange for the work that Orangecrest Community Church of Riverside, California Incorporated ( OCC ) and its agents (including any host organization) have done to organize my 2015 Mission Trip ( Mission Trip ). I acknowledge that their efforts have included finding locations for the trip, arranging travel and accommodations. In connection with the trip I have also received and expect to receive as part of the Mission Trip: training, supervision, guidance and spiritual growth and service opportunities. I understand that OCC will not allow me to participate in the Mission Trip unless I enter into this 2015 Mission Team Waiver / Release Agreement (the Agreement ). Therefore, in exchange for permission to participate, I make the following statements and agreements, which I understand the Church is relying on: I am the Participant named above. I am eighteen (18) years of age or older, of sound mind, in good health. There is no physical or mental conditions will hinder me participating in the Mission Trip identified above. I understand that the terms of this Agreement are contractual and legally binding on me, and on my representative heirs, estates, beneficiaries, successors, and assigns. I have read and understand this Agreement. 2. Explanation of trip/activity I am a volunteer embarking on a Mission Trip with other volunteers. I am choosing to participate on this Mission Trip as a volunteer and I expect to serve the needs of local ADULT RELEASE PAGE 1

2 organizations and the community in the location of the Mission Trip. The benefits I am expecting are spiritual rewards from participation and service. While there may be opportunities for sight seeing, I do not expect my experience to be anything like a vacation. I know that OCC representatives have contacted people in the area of my Mission Trip and that they have sought to make my Mission Trip safe, however, I am not relying on any statement by anyone on behalf of OCC that this Mission Trip is risk free. I fully understand and acknowledge that participating in Mission Trip may entail hazards, dangers, and other risks. Such risks have always been associated with missionary service (2 Corinthians 11:23-28). Such Risks and Dangers may include, but are not limited to, the following risks and risks like the following: war, uprisings, political coups, terrorism, terrorist acts, kidnapping, murder, any other criminal activity, random acts of violence, poor sanitary conditions, food that is unsafe to eat, water that is unsafe to drink, unsafe recreational activities, illness, dehydration, inadequate protection or no protection from weather conditions, inadequate medical services or the absence of medical services, failure of transportation, inadequate or unsafe hotel or housing accommodations, exposure to illness, exposure to criminals, exposure to homeless individuals, and exposure to protesters. By my participation in the Mission Trip, I knowingly and voluntarily expose myself to these risks and dangers, and any other risks whether expected or unexpected; whether known or unknown. I embark upon the Mission Trip with full awareness of these risks, and, I voluntarily assume all risks of illness, injury or death associated with the Mission Trip, as well as any damage to my personal property. If I do not follow the guidance of the leaders I know I may be sent home, and if for any reason I am unable to complete my stay during the Mission Trip, I assume responsibility for expenses incurred for my return home. I am aware that I may obtain insurance coverage at my own expense. I further understand that the insurance obtained by OCC has a one million dollar limit per occurrence and may not be sufficient insurance coverage to cover the full cost, expense or damage which might result from my illness, injury, or death, or damage to my property during the Mission Trip, especially if circumstances arise which result in illness, injury, death or damage to multiple members of a mission team. 3. Permission for Treatment In the event of an emergency, I hereby authorize any adult member or leader of this Mission Trip as an agent for me, to consent to: any x-ray examination; medical, dental or surgical diagnosis; treatments; hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state or country where services are rendered, either at a doctor s office or in a hospital. Or if no such medical or dental professional is timely available, by such other medical or dental ADULT RELEASE PAGE 2

3 personnel as are available to deal with the emergency. In the event of an emergency I expect my family to be contacted as soon as possible. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, I agree to pay for the medical treatment. 4. Release - Waiver Participant and the Releasing Parties release, waive, discharge, indemnify, and hold harmless OCC and the Released Parties from all Legal Actions and Claims and any Resulting Consequences Arising from any Cause. Participant and the Releasing Parties includes the Participant, his or her representatives, heirs, assigns, estates, agents, executors, administrators, guardians, personal representatives, and attorneys. Orangecrest Community Church and the Released Parties includes Orangecrest Community Church of Riverside, California Inc., and the host organization or organizations, and all of their respective staff, employees, agents, assigns, Advisory Team members, church members, officers, directors, representatives, agents and attorneys. Legal Actions and Claims include: ANY AND ALL POSSIBLE CLAIMS AGAINST ORANGECREST COMMUNITY CHURCH AND THE RELEASED PARTIES FOR ANY ACT OR OMISSION, INCLUDING CLAIMS FOR NEGLIGENCE REGARDING INJURY OR PROPERTY DAMAGES ARISING OUT OF MY PARTICIPATION IN THE MISSION TRIP. Resulting Consequences include: and expected or unexpected conditions, developments or risks connected with domestic travel, foreign travel, or staying in a foreign country, even if I suffer the loss of money, property, health, or life, and irrespective of who is or may be at fault, or whose negligence, including the negligence of OCC may have caused my loss, injury or death. Arising from any Cause means but is not limited to a direct cause or indirect cause, any cause however remote or tenuous, multiple causes, natural causes, actions taken by third parties, and any cause or act in a chain of events. 5. Cost of unscheduled return travel I understand that Participants are expected to abide by all rules of OCC, and to represent Jesus Christ, my family and OCC. Participation in the Mission Trip events or programs is ADULT RELEASE PAGE 3

4 a privilege and this privilege may be denied by a Mission Trip Leader if in his sole opinion, my attitude or actions are disruptive or fall short of the required standard. I understand that the Mission Trip Leader may require in his judgment that I be sent home. I agree to pay or reimburse OCC for all of the costs associated with returning me to my home. If I am sent home by a Mission Trip Leader for disciplinary reasons, I agree that I will NOT receive a refund of any costs, charges or expenses associated with the Mission Trip. 6. Resolution of Disputes I recognize that Christians are called by scripture to a different standard of resolving their differences (Matthew 18; 1 Corinthians 6). In the event a dispute arises out of, or relates to this Mission Trip, I shall first make a good faith attempt to settle the dispute by mediation administered by the religious dispute division of Mediation Law Group TM (MLG), a Certified Christian Conciliator certified through Peacemaker Ministries, or another Christian dispute resolution service, before commencing arbitration, litigation, or other dispute resolution procedure. In the event I am unable to resolve the dispute by mediation, I shall submit any claim(s) I have to binding arbitration administered by the religious dispute division of MLG, or another Christian dispute resolution service, under its arbitration rules, and I agree that judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. I further acknowledge that where emergency interim relief is required by a party to this agreement, including but not limited to injunctive relief and orders for the protection or conservation of property and/or disposition of disposable goods, such relief may be granted by an arbitrator upon application under applicable arbitration rules, even when the dispute is still in the mediation phase of resolution. I acknowledge and agree that an application for such emergency interim relief shall not constitute a waiver or breach of the mediation or arbitration requirements of this agreement. 7. Permission to use image I grant Orangecrest Community Church its representatives and employees permission to photograph and/or film me I agree that my image may be used in video presentations, printed publications, or on Orangecrest Community Church s website(s). Full names or addresses will not be published to the internet. I understand that any such photographs, films or video and the like may be used for promotion of the activities of OCC which may include outreach and fundraising efforts. In addition, local news organizations may hear of our activities or events, and OCC may invite or allow them to photograph or record our events for news reporting on special interest features. In addition I agree to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media. I grant this permission for an indefinite period of time unless otherwise revoked by me in writing and delivered by certified mail, return receipt ADULT RELEASE PAGE 4

5 requested, to: Orangecrest Community Church, 5005 La Mart Dr., Suite #202, Riverside CA I agree to the terms of this paragraph. (Initials of Parent, Guardian or Conservator) 8. Current Prescriptions, Allergies, Current conditions, Medical & Health Insurance Information I have checked the appropriate blank if I have ever had any of the following: Allergies (incl. drug) Asthma Bee/Wasp Reaction Diabetes Epilepsy High Blood Pressure Dizziness or Fainting Hay Fever Heart Trouble Operation in last year Penicillin Allergy Regular Medication Physical Handicap Pregnant Respiratory Problems Any Problem not listed (attach explanation) List: Last Tetanus Shot Date: I agree to take an ample supply of any regular medication for the length of the Mission Trip and a written prescription from a doctor. Any other information leaders should know about me relevant to this Mission Trip is on an attached sheet of paper dated and signed by me. 9. Emergency contact IN CASE OF EMERGENCY CONTACT: Relation to you: Daytime Ph: Evening Ph: Cell Ph: Address: City: State: Zip: ADULT RELEASE PAGE 5

6 10. General Provisions If any term or provision of this Agreement is found to be unenforceable, the remaining terms and provisions shall remain in full force and effect. If suit is brought to enforce this Agreement and if the arbitration provisions are not enforced or enforceable, then jurisdiction and venue of the suit shall be in the United States District Court of the Central District of California, and in any case, California law shall apply. This Agreement and documents referred to or attached to this Agreement contains the entire agreement concerning my participation on the Mission Trip and there are no other agreements that govern the subject matter of this Agreement. 11. Signatures Agreed to by: Participant Printed Name Participant Signature Date Bruce Wood for Orangecrest Community Church ADULT RELEASE PAGE 6

These forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT

These forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT Our vision for global(x) trips is that they will be opportunities for people to pursue spiritual growth