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Permission, Medical Release, Risk Disclosure, and Guidebook Review Form

TODAY'S DATE: March 28, 2024

Permission and Medical Release:

This Release is made in favor of A Child's Hope Foundation of 165 N 1330 W, Ste. A1, Orem, UT 84057, hereafter referred to as the Releasee. This Release includes all officers, directors and employees of the Releasee, as well as Releasee's successors, assigns, and legal representatives. The consideration for this Release is the permission given to the Participant to participate in the Service Trip.

This Release binds not only the Participant (and the Participant's Guardian(s) as applicable) with regard to any claims arising from participation in this Service Trip, but also the spouse, heirs, legal representatives, and assigns of the Participant (and the Participant's Guardian(s) as applicable). The Participant (and the Participant's Guardian(s) as applicable) release Releasee from any and all claims for loss or damage, including personal injury or death, whether or not caused by Releasees negligence, while participating in the Service Trip.

In the event that any medical attention is necessary, The Participant (or The Participant's Guardian(s) as applicable) hereby authorize any physicians or other medical personnel involved in the Volunteer Trip to administer such medical or surgical treatment or carry out such procedures as may be deemed necessary or advisable in the diagnosis and treatment of the Participant by the physician or other medical personnel.

The Participant understands that it is their responsibility to obtain needed vaccines and be up to date on vaccines that the CDC recommends, which include Measles, Hepatitis A, Typhoid, and Routine Vaccines. Those vaccines can be found through this link: https://wwwnc.cdc.gov/travel/destinations/traveler/none/mexico.

The Releasee will be taking photographs and video of the Participants to be used by the Releasee in promotional materials. The Releasee is granted by this Release the right to photograph and film the Participants, as well as to display, exhibit and utilize the photographs/film. The Participant (and the Participant's Guardian(s) as applicable) release Releasee from any future claims for libel, slander or any claim by the Participant (and the Participant's Guardian(s) as applicable) or their successors and assigns.

If any portion of this Release shall be held to be invalid under the laws of the State of Utah, those parts that are not held invalid shall continue in full force and effect.

Trip Risk Disclosure:

​Please check each box below to acknowledge your understanding of the potential risks associated with your service trip’s activities:

Construction-related injury

Volunteers may be asked to lift heavy items or operate equipment such as a cement mixer, power drill, power saw, etc. Assignments are voluntary and may be declined at any time. Consult a doctor before participating.

I Agree
 

Sport-related injury

Volunteers are invited to participate in different sporting activities during service trips (e.g. soccer, basketball, volleyball, swimming, and children’s games such as tag, hide and go seek, etc.). Participation is voluntary. BAJA ONLY: ACHF does not recommend swimming in the beaches near Baja, California due to dangerous riptides. If you choose to swim at your own risk, check and double check the status of riptides, use life vests for children, and do not overestimate your own swimming ability. Stay where you can touch the ground at all times.

I Agree
 

Theft of personal property or vehicle

ACHF is not responsible for lost or stolen items from a volunteer’s vehicle or the group van. If you choose to bring valuables outside of the dorms, it is recommended you keep these items out of sight. Be aware, Mexican car insurance is required if you will be driving your personal vehicle across the border (Mexico trips only).

I Agree
 

Lost & Damaged Items

Be advised that A Child's Hope Foundation cannot be responsible for any lost or damaged items.

I Agree
 

Disease or illness

Traveling in a foreign country may increase your risk of illness or disease. Please consult your physician to ensure proper health before attending, including verification that shot records/vaccinations are up to date.

I Agree

Firearms

MEXICO ONLY: It is ILLEGAL to carry firearms or ammo into Mexico. Please ensure any such items (including any used shells) are removed from your vehicle and luggage before crossing the border. For more information about customs, visit https://www.cbp.gov/travel/us-citizens/cbp-reqs-mexico. 

I Agree

Photography Release

Participating in a service trip with A Child’s Hope Foundation may result in photography, video, or other media featuring you or your attending family members. This media may be used for promotional purposes, including use on social media, website, and marketing materials. If you have special circumstances, please contact the volunteer coordinator at info@achf.org.

I Agree

Travel Expenses

Travel expenses incurred to attend a service trip with A Child's Hope Foundation (including airfare, vaccinations, and so forth) are the responsibility of the participant. At times, A Child's Hope Foundation may need to cancel a trip due to safety concerns or because minimum numbers on the trip have not been met. I recognize that A Child's Hope Foundation is not responsible for my travel expenses, and I have been encouraged to purchase refundable fares.

I Agree

Background Check

For the safety of the children at the home/orphanage locations where participants live and work while on a trip with A Child's Hope Foundation, A Child's Hope Foundation will perform background checks on all trip participants 18 years or older. Information from the background check will be available to A Child's Hope Foundation to determine if any trip participant does not meet the home/orphanage visitation requirements. I acknowledge and give A Child's Hope Foundation my permission to perform this background check.

I Agree

Rental Van

DRIVER: If I am the individual who drives the rental van, I recognize that the safety of all passengers in vehicle is mine. I acknowledge that I should obey all driving laws and encourage every individual to wear a seatbelt. I promise to have insurance that covers rental vehicles in the case of any injuries or accidents. I acknowlegde that ACHF is not liable for any accidents.

PASSENGER: I acknowledge that I should obey all driving laws and wear a seatbelt. I promise to have insurance that covers rental vehicles in the case of any injuries or accidents. I assume the risk of driving in a vehicle with someone else driving and not in my own vehicle. I acknowlegde that ACHF is not liable for any accidents.

I Agree

Acknowledgement

I acknowledge that it is my responsibility to address any specific questions about my or my family’s safety with the volunteer coordinator or trip host before attending the trip.

I Agree

Guidebook Review:

I appreciate the opportunity A Child's Hope Foundation is giving me to participate in a service trip. I realize the purpose of the Service Trip Guidebook and the Orientation is to help prepare me for the experiences I will have and to set forth the expectations the organization has for me. I commit to attending the orientation meeting or scheduling a phone call with an agent of A Child's Hope Foundation to ask and receive answers to my questions about the service trip.

I have read and understood the information contained in the Service Trip Guidebook, including the Child Protection Policy. I fully commit to abide by the standards at all times during my participation in the service trip. I understand that failure to follow these guidelines or directions given to me by an agent of A Child's Hope Foundation could result in me being sent home. Should I be sent home early, I understand that I would be responsible for bearing those costs, in addition to forfeiting all fees paid to A Child's Hope Foundation to participate on the service trip.

I further understand that the country I am traveling to is a developing country, and as such, many rules, laws, and customs are different than they are in the United States. I understand that the possession of, or involvement with, any illegal drugs is prohibited. If arrested while on the service trip, individuals accused of involvement with drugs should not expect any assistance from the U.S. Government or A Child’s Hope Foundation. Note: It is illegal to bring firearms, ammunition, or other weapons into Mexico. Please make sure that you do not even have spent shells in your vehicle. 

I understand that I must be able to live, for the designated period of time, away from home and without assistance while providing for my own basic needs. I do not have any significant physical or mental challenges or constraining behavioral conditions that would affect my participation in any way during this service trip that I have not disclosed to A Child’s Hope Foundation.

I commit to NEVER going anywhere alone. I will stay in a group of at least three or more and make sure that my travel leader knows exactly where I am at all times.


I commit to doing everything in my power to protect children from abuse and will follow the guidelines outlined in the Child Protection Policy.

I understand that my name, email, and phone number will be shared with other members of the group in order for A Child’s Hope Foundation to organize the group in preparation for the trip and to contact the group while traveling. I also understand that A Child's Hope Foundation may send emails following the trip to inform me of its mission and needs.

 

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Medical Information: 

(Please check all that apply)
Special diet
Allergies
Daily or Required Medications
Chronic/recurring illness
Physical condition that limits activity
Surgery or serious illness in the past year
Other medical needs / conditions

If yes to any of these questions, please explain:
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
I, the parent or guardian of the minor, declare that I have reviewed the guidelines contained in the Volunteer Trip Guidebook with my son / daughter and we fully understand the requirements for their participation. We have further discussed the consequences of inappropriate behavior, including the possibility of being sent home early. I understand our responsibility to pay the fees associated with an early departure. I, also commit to watching the video orientation and to calling or emailing an agent of A Child's Hope Foundation to ask any questions I may have before the trip begins. I hereby give full permission for the Participant to participate in the Volunteer Trip.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Medical Information: 

(Please check all that apply)
Special diet
Allergies
Daily or Required Medications
Chronic/recurring illness
Physical condition that limits activity
Surgery or serious illness in the past year
Other medical needs / conditions

If yes to any of these questions, please explain:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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