I, the undersigned, desire to travel to Africa under the auspices of Africa Christian Training Institute (ACTI). I understand that such travel may be hazardous and involve the risk of injury, sickness and possibly death, as well as damage to property, when traveling and/or in the African country (usually Uganda). I understand that I may need to travel and live in very primitive areas, risk violence from crime, war, and political unrest and other dangers, and may be exposed to food and water-borne diseases and to disease from other carriers. I understand that some diseases may not produce symptoms during the actual trip, but may occur after the trip. I understand also that medical facilities in Africa may not be of the quality of medical facilities in the United States. I understand that I may be injured if involved in a construction project. (_______)Initial
I understand that there may be delays and sudden change of schedules and/or cancellation of schedules. While reasonable care will be taken to maintain the vehicle used in transport in Uganda (if owned by ACTI), I understand that breakdowns may occur.
I acknowledge that I am in good physical condition. I understand also that the journey may involve strenuous physical activity, including, but not limited to, long walks and hiking in hills and or/mountainous areas. (________) Initial
I voluntarily and personally assume the risk of any and all consequences of my travel with ACTI (that is, travel using ACTI personnel and services). I expressly waive my right and the right of any of my heirs, legal representatives and assigns to sue or otherwise collect damages from ACTI, its officers, personnel or volunteers, or from my church, its officers, personnel or volunteers, resulting from personal injury, property damage, delays and change of schedule and wrongful death.
If any part of this agreement is not valid or declared to be so by a Court of Law, I agree that the remaining portions will continue in full force. (_________) Initial
I, the undersigned, have voluntarily and without duress signed this WAIVER OF LIABILITY form. I assert that I have read and fully understand the above WAIVER OF LIABILITY.
Printed Name_________________________________________________________________Age____________
Signature__________________________________________________________________Date______________
Acknowledgement: State of:__________________________City of:______________________________________
The foregoing Waiver of Liability was acknowledged before me this _____________day of,____________________,
199____, by_____________________________________, after proper identity was established.
| NOTARY SEAL |
Notary Public in and for the State of________________
My Commission expires:_________________________ |