Team Leader Assumption of Risk

Name
First Last
In consideration of my being permitted to work as a volunteer with Breathe Partners and Team Leader, recognize I am not an employee of Breathe Partners and represent that I am at least 18 years of age or am under the supervision of a legal guardian or a church leader, and I further represent and agree as follows:
We are aware of the hazards and risks to our person and property associated with serving in a missions capacity, such hazards and risks including, but not being limited to, death or injury by accident, disease, war, terrorists acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. We accept the assignment with full awareness of these risks, and, subject to the required insurance coverages described below, we voluntarily assume all risks of death, injury, illness, and damage to ourselves or any member of our family associated with such risks, and any damage to my personal property. We further recognize that such risks have always been associated with missionary service (2 Corinthians 11:23-28).

We attest and certify that we have no medical conditions that would prevent us from performing our duties.

We waive and release any and all claims for damages which we, or our heirs or successors, may have against Breathe Partners, the Fellowship of Grace Brethren Churches or any of its National Organizations and Cooperating Ministries, or any of its Partner Mission Organizations, or any agent or employee of any of such organizations, arising from my death, injury, or illness, or any property damage or loss occurring during the term of our assignment or as a result of this assignment.

We understand and accept the following policy of Breathe Partners regarding ransom payments: Breathe Partners has determined that it will not pay ransom nor yield to the demands of anyone who takes hostage one of our missionary family or staff hostage. Breathe Partners pledges itself to every effort in prayer and all other appropriate means to obtain the release of one taken hostage should it ever occur. This policy was made after sufficient study of the policies of other evangelical missionary societies and after considering the advice of the United States State Department.

We expressly waive any defense to the enforcement of any provisions 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.

By signing this form, I am signifying that everyone on my team has read the assumption of risk form, signed it and will not hold Breathe Partners liable in any way and has also purchased trip insurance as outlined below.

We expressly agree that this assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by law. We further state that we HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND ITS CONTENTS, AND WE VOLUNTARILY SIGN THIS RELEASE AS OUR OWN FREE ACT.
INSURANCE
We are aware of the hazards and risks to our person associated with serving in a mission’s capacity, as described above. We further understand that Breathe Partners requires insurance coverage summarized below:
 $100,000 accidental death and dismemberment
 $50,000 accident medical limit
 $10,000 sickness medical limit
 $50 deductible per occurrence
 $75,000 medical evacuation limit
 $10,000 repatriation limit
Securing Insurance
- I and everyone on my team has secured a missionary ‘rider’ to my and their personal insurance policy or have secured this coverage through the church missions insurance for the period of this experience with Breathe Partners. Submission of names on this coverage is required. This MUST include emergency evacuation. A copy of procedure and contact info must be sent to Breathe Partners so they will know what to do in the case of emergency.
- I and everyone on my team has secured Insurance through the Breathe Partners provider. The cost of this insurance is approximately $15 per week. The participant, by checking this box is stating that it has or will secure and pay this insurance prior to their mission trip experience. It is the participant’s responsibility to contact and purchase this insurance directly through www.missiontripinsurance.com on their own. Individuals or groups can contact the Breathe Partners Insurance partner. Please state that you are part of a mission team serving with Breathe Partners. You can find our insurance provider on the Breathe Partners website by clicking the Haiti page link.
Date*
Signature*