The following form is the standard liability release that DOCARE asks all volunteer participants to sign. It is included in our application for short-term trips, and our application for rotations, and can be completed via those mechanisms. The copy of the liability release below is provided for the perusal of prospective and actual participants who wish to review it.
Release from Liability and Acknowledgement of Assumption of Risk
I apply to DOCARE International NFP (“DOCARE)”, an Illinois not for profit corporation with offices located at 142 East Ontario Street, Chicago, Illinois, to participate in the upcoming global health outreach opportunity with DOCARE.
In making this application, I understand and agree that:
- I will participate in this outreach opportunity as my free and voluntary act.
- I recognize and assume all risks and expense as a result of participating in the global health outreach. These risks include but are not limited to:
- Exposure to blood-borne pathogens and other potentially infectious materials, where ability to access immediate treatment may be limited.
- Personal injury. Accidents inherent to travel in motorized vehicles.
- Sickness including exposure to endemic infectious disease.
- I understand my existing health care coverage will most likely not provide any coverage outside of the United States and that I have been advised to obtain additional coverage at my own expense.
- DOCARE has determined that it is necessary for all volunteers to purchase medical/evacuation insurance as most insurances based in the US do not provide coverage outside the country. Medical care outside of the US can be very costly, and many providers ask for payment first. In the event medical evacuation is needed, the costs can exceed $200,000 US dollars.
- It is important to know that most travel insurance policies do not cover incidents that occur as a result of high risk activities (mountain climbing, scuba diving…) even with high risk activity riders. They also do not cover incidents that occur as a result of alcohol use and drug use is strictly prohibited. Thus, we recommend that all participants exercise caution with regard to these activities.
- Some vendors for the medical/evacuation insurance can be found on the Resource page of our website: http://docareintl.org/links-resources/
- My travel to and presence in a foreign country will expose me to potential risks of disease, injury and physical and emotional harm, including death, that I would not otherwise be exposed to.
- DOCARE is not a travel advisory service. It is my responsibility to review information from the U.S. State Department and other organizations regarding the travel risks involved for the host country.
- I understand that laws of the host country will apply, and I will be subject to the host country’s jurisdiction.
- I bear full legal and financial responsibility for myself, including responsibility for all indebtedness or other legal obligations incurred by me while participating in this global health outreach.
- DOCARE shall have the right to require my withdrawal from the global health outreach if it is determined in DOCARE’s sole discretion, that my ongoing participation may be detrimental to me, to others, or to DOCARE.
I, do for myself and my heirs, executors, administrators, legal representatives and assigns (hereafter, collectively, “I” or “me”) hereby release, forever discharge and agree to hold harmless DOCARE International, its directors, officers, agents, employees and clinic staff and employees from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by me in connection with or resulting from my participation in the DOCARE global health outreach.
I certify that I have read and fully understood the provisions of this Release from Liability and Acknowledgment of Assumption of Risk and had the opportunity to review it with an attorney of my choosing if I so desire. I agree to be legally bound by this Release.
How to Complete This Form?
If you have questions, please contact the DOCARE secretariat at email@example.com.