By typing my full name here and submitting this form, I * acknowledge and agree that I have read, understood, and agreed with the following conditions regarding my Outreach Trip provided by AMAZON PROMISE (“AP”), which is scheduled to take place on the following Trip Dates from * to* ("Outreach Trip").
1. I acknowledge and agree that I have been asked to consult a qualified medical practitioner regarding my ability to undertake this Outreach Trip and I have no physical or psychological condition that would preclude my participation or pose an unreasonable risk to others or myself during my Outreach Trip. I further acknowledge and agree that I am following my medical practitioner’s advice about my possible need for vaccinations and/or medication before and during my Outreach Trip.
2. I acknowledge and agree that I have been told that my destination in the Amazon jungle is in a remote area far from modern health clinics or hospitals. If a physical or psychological condition should develop, a) AP is not responsible or liable for any delay or inadequacy in my receiving medical treatment, and b) I agree to reimburse AP for any costs incurred in connection with my evacuation and/or hospitalization.
3. I acknowledge and agree that I have been informed and I understand that there are certain obvious risks inherent in any trip to a South American city and the Amazon jungle (including the risk of personal injury and/or death) and I freely and voluntarily accept those risks. I understand AP can neither eliminate all such inherent risks nor guarantee a traveler’s personal safety. I also understand that AP nether implies that evacuation is available or possible in the event of hostile circumstances. In the event of an emergency evacuation, I agree to reimburse AP for any costs incurred with my evacuation.
4. In consideration for the services provided by AP in connection with the Outreach Trip, I, for myself and my executors, administrators, heirs, next of kin, successors, and assigns, hereby do and shall release, acquit, discharge, and forever indemnify and hold harmless AP, and each and every one of its directors, officers, employees, volunteers, owners, representatives and agents and their respective successors and assigns from and against any and all liability, loss, cost, damage, expense (including reasonable attorney’s fees) or other claim or action of any kind that may arise or occur on account of or in connection with the Outreach Trip, including without limitation any liability for death, disability, personal injury, property damage, property theft, any claims for negligent acts or omissions or any claims resulting from: acts of God; detentions; government restrictions; delays or cancellations beyond its control; strikes; thefts and other crimes; vehicular accidents; acts of war; civil disturbances; political unrest; sickness or infections; weather; personal mishaps such as slipping and falling; and encounters with hostile governments, individuals, wildlife, plants, and other jungle aspects.
5. I understand that any and all film images made during the Outreach Trip in which I appear may be used for publication and/or display to promote AP’s non-profit mission and that I will receive no financial compensation for the film image used.
6. If my financial pledge to AP has not been received in full, if my credit card is denied or my check is returned by my bank, I will be responsible for all pledge fees and costs required to fulfill my financial obligation to AP.
7. In the event of my serious personal injury or death during the Outreach Trip, I hereby authorize and direct AP to notify the following person(s):