Consent for Treatment
In the event of an emergency, I hereby give permission for transport to a medical facility and hereby agree to the performance of such treatment, anesthetics, and operations as the opinion of the attending medical professional deems necessary for the participant named below.
Liability Release
The applicant named in this form, who is herein referred to as the "Releaser", hereby releases, waives and forever discharges the UNIVERSITY OF THE NATIONS, INC., a Cambodian Non-Government Organization, its trustees, directors, officers, agents, employees, if any, successors, insurers and volunteers, who are herein collectively referred to as the "University" from any and all liability, claims, causes of action, loss and damage that may result from any injury to the Releaser’s person or property, even injury resulting in death of the Releaser, arising out of the Releaser being a Student, a Mission Builder, and/or a Full Time or Associate Staff member at or of the University, including without limitation of the generality of the foregoing those arising out of or in any way related to the Releaser participating in any University conducted or sponsored program or activity whether on the University Battambang, Cambodia campus, off campus within or outside of Cambodia such as an outreach program, which could be conducted outside of Cambodia.
Releaser hereby acknowledges that if Releaser participates in an outreach program conducted or sponsored by the University or travels internationally on University business that he or she is fully aware of the fact that his or her personal health, freedom, safety and/or life may be at risk of loss or damage from contraction of
disease, accidents, terrorism, persecution, war, political unrest and any other number of circumstances that might while traveling internationally or while participating in an outreach program and that the Releaser will give such risks the Releaser’s full consideration, prayer and thought in deciding whether or not to participate in any such activity and has given such risks the Releaser’s full consideration, prayer and thought in deciding whether or not to sign this instrument and that Releaser has signed this instrument with full knowledge of those risks, voluntarily, and not under any duress or undue influence of whatsoever kind or nature.
Releaser hereby knowingly and voluntarily assumes full responsibility for risk of loss of health, bodily injury, death or damage to Releaser’s property arising out of the aforedescribed risks, programs and activities. Releaser hereby agrees to indemnify and hold the University harmless from any and all claims, liability, loss, damage, cost and/or expense, including attorneys’ fees and costs incurred by the University in defending against any such claims and in enforcing this agreement, that may be asserted against the University or that the University may suffer or incur as the result of Releaser being a Student at the University or being a Mission Builder, and/or a Full Time or Associate Staff member at the University as the case may be.
Releaser expressly agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as possible for any jurisdiction in which any cause of action or claim may arise or be asserted and is being given as an inducement to the University to allow Releaser to be a Student at the University or be a Mission Builder, and/or a Full Time or Associate Staff member at the University, as the case may be, and that if any portion of this agreement is invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect. This release, waiver and indemnity agreement shall be binding on Releaser and Releaser’s heirs, personal representatives, successors and assigns and shall insure to the benefit of the University and its trustees, directors, officers, agents, employees (if any), insurers and volunteers.
RELEASOR ACKNOWLEDGES RELEASOR HAS CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTANDS ITS LEGAL EFFECT AND HAS SIGNED IT OF RELEASOR'S OWN FREE WILL.
I, the undersigned, expressedly agree that by signing this release, I give consent to the University of the Nations concerning any legal obligation that may arise from activities undertaken with and for UofN Battambang. I recognize that this document is intended to be as inclusive as possible and agree that if some portion of this document is made invalid, I agree to abide by any other portions of the agreement that remain in full legal force and effect. I recognize that by agreeing to serve in the capacity of a Student, Mission Builder, and/or Staff Associate of the University that I do so at my own risk, recognizing and taking responsibility for the possible risks and dangers possible with the position. This agreement shall be binding on Releaser and Releaser’s heirs, personal representatives, successors and assigns and shall insure to the benefit of the University and its representatives.