PARTICIPANT RELEASE AND WAIVER

(Must Be Signed by HOPE WORLDWIDE CENTRAL JERSEY CHAPTER Participants who are 18 and older on the date of execution, and/or parent/guardian)

I, ______, upon approval to participate in HOPE WORLDWIDE CENTRAL JERSEY CHAPTER Summer in Exuma, Bahamas at the Exuma Foundation, acknowledge that I have received, read and understood the materials provided to me, which describe the activities that I will be engaged in during our trip fromJuly 18- 25, 2015 for a few volunteers. I understand that my participation in volunteer activities may involve programs located in devastated neighborhoods ofExumawhere I may encounter poor living standards, unclean or dangerous environments, and unstable political climates. I understand that such program locations may present inherent dangers that could result in injury, illness and/or loss of life to me. I understand that the activities that I may engage in may present unique risks such as contracting a serious illness or sustaining personal injury. I understand that HOPE WORLDWIDE CENTRAL JERSEY CHAPTER Coordinators and THE EXUMA FOUNDATION take reasonable precautions to prevent any of these adverse consequences against its participants, such as warning against the dangers, suggesting that participants consult with medical authorities regarding appropriate vaccinations, and educating its participants on how to handle potential problems. Nevertheless, I understand that these matters are largely, and at times, entirely beyond the control or influence of these volunteers and therefore, represent risks that I must seriously consider in executing this release and waiver. Having been fully informed of such risks, I hereby agree to assume the risks described above and hold harmless and release from any and all liability, the Central Jersey Church of Christ/HOPE WORLDWIDE CENTRAL JERSEY/THE EXUMA FOUNDATION, their board of directors, officers, employees, agents, volunteers, affiliates, sponsors and promoters, as well as their respective, directors, officers, employees, and agents, for any injury, illness or death to myself, arising out of or in connection with my participation in HOPE WORLDWIDE CENTRAL JERSEY CHAPTER/THE EXUMA FOUNDATION event. Also, to the fullest extent allowed by law, I hereby waive and discharge my rights, including those of my heirs or assigns, to any and all claims of damages for injury, illness or death to myself, or for loss or damage to my property, against the Central Jersey Church of Christ/The Exuma Foundation, arising out of or in connection with my participation withHOPE WORLDWIDE CENTRAL JERSEY CHAPTER. To the best of my knowledge, I have no physical or medical condition which would in any way restrict or interfere with my ability to participate withHOPE WORLDWIDE CENTRAL JERSEY CHAPTER/The Exuma Foundation, or that may present a danger to the well-being of myself or others. I agree that health insurance coverage for myself is my sole responsibility. In case of an emergency, I hereby give permission for the person(s) leading or directing this activity, to use their best judgment in obtaining medical attention or treatment for me if such attention or treatment is required during HOPE WORLDWIDE CENTRAL JERSEY CHAPTER/THE EXUMA FOUNDATON event. I further give permission to the physician or other medical professional that is selected by the Coordinators, to render medical attention or administer medical treatment as the physician or medical professional deems appropriate and necessary. I also give permission for the Coordinators to render any assistance (e.g., first aid, CPR) to me in the event of injury or illness.

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HOPE WORLDWIDE CENTRAL JERSEY CHAPTER Participant’s Signature Date

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HOPE WORLDWIDE CENTRAL JERSEY CHAPTER Participant’s Name (Printed or Typed) Date

Confidential Health Form

Participant’s name ______

In an emergency, contact ______Phone______

Medical Insurance Company ______Ins. #______

PERSONAL HISTORY: Please circle all ‘yes’ answers and explain in the space below.

Does the participant have or ever had any of the following?

Allergies (specify)

Shortness of breath

Stomach/duodenal ulcer

Hay fever, asthma

Skin Conditions

Hepatitis

Diabetes

Heart Trouble

Intestinal troubles

Headaches/Migraines

High or low blood pressure

Head Injury

Epilepsy

Seizures

Anemia

Eating Disorder

Rheumatism/arthritis

Fevers

Mental/Nervous Disorders

Dysentery

Back problems

Malaria

Weakness

Paralysis

Broken bones

Insomnia

Fainting Spells

Eye/Ear Trouble

Surgery (specify)

Tuberculosis

Irregular periods

Severe cramps

Excessive flow

If yes, please explain. ______

Is the participant currently under doctor’s care for any condition? Yes (specify) No

Is the participant taking any medication at this time? Yes (specify) No

Does the participant have any physical disabilities/emotional /health conditions that require special attention? Yes (specify) No

Additional special needs:______

Would you rate participants overall health condition as: Excellent Good Fair Poor

I have read the Confidential Health Form and agree that to the best of my knowledge it is correct and complete as it stands. I/we also agree to hold the Central Jersey Church of Christ, its employees and the volunteers harmless from all liability resulting from any accidents or illness to the participant. I verify that all information on this form is complete and accurate and I have read and understand all information contained herein.

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Participant Signature Date

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Parent Signature (for participants under 18 years old) Date

TERMS AND CONDITIONS FORM

Thank you for your desire to participate in HOPE WORLDWIDE CENTRAL JERSEY CHAPTERBahamas Trip. It is a great opportunity and honor. In order to communicate the importance of your responsibility as a participant in HOPE WORLDWIDE CENTRAL JERSEY CHAPTER, we have provided below an outline of your responsibilities.

I, ______and ______understand that

HOPE WORLDWIDE CENTRAL JERSEY CHAPTER participant Parent or Guardian, if participant under 18

I have chosen to participate in HOPE WORLDWIDE CENTRAL JERSEY CHAPTERSummer in Exuma, Bahamas2015 and I am agreeing to the following terms and conditions:

Please read and initial the following statements (parent or guardian must also initial if participant is under 18):

_____I will submit the required deposit and payments.

_____I will notify the HOPE WORLDWIDE CENTRAL JERSEY CHAPTER

coordinators of any changes in my contact information (including my

address, phone number or e-mail address).

_____I will take the time to read and understand each of the requirements for

participation in HOPE WORLDWIDE CENTRAL JERSEY CHAPTER and

will return any required paperwork by the deadlines assigned.

_____I will accept responsibility for obtaining, at my expense, any additional

documents (i.e. passport, Visa) or immunizations required for my

participation in the HOPE WORLDWIDE CENTRAL JERSEY CHAPTER.

_____I will abstain from the use of ANY substances that contain tobacco, alcohol

or drugs that have not been prescribed for my use by a physician while

participating in HOPE WORLDWIDE CENTRAL JERSEY CHAPTER,

regardless of the legal age of consumption in the country I am visiting. I

understand that if I do use a substance that contains tobacco, alcohol or

an inappropriate use of drugs, I will forfeit theremainder of my experience

and will be sent home, at my expense.

_____I (and/or my parents) will remain a member in good standing with the

Central Jersey Church of Christ or a church that is in fellowship with the

Central Jersey Church of Christ. If for any reason I do not remain a member in good standing, I will forfeit my opportunity to attend HOPE WORLDWIDE CENTRAL JERSEY CHAPTER.

_____I have read the following book(s) in preparation of this trip:______

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Signature of Participant Date

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Signature of Parent (if Participant is under 18) Date

VOLUNTEER SUPPLY LIST
Official
Valid Passport and/or Visa (non-US citizens)
Vaccinations
Submit forms, copies of Passport, and Insurance Cards to Trip Coordinator
Health and Wellness / Nutrition
Imodium / Power/Protein Bars
Pepto Bismol / Trail Mix
Malaria Pills
Bug Repellant
PUR tablets
Multivitamins
Sunscreen
Antibiotic Prescription
Benadryl or Sleep aid
Bedding for Dorm / Hygiene
Bath/Beach Towel/Wash Cloth / 3 oz Toiletries
Bed sheets and pillow case / Personal wipes
Hand Sanitizer
Toilet paper* If you are in the dorm
Clothing
Jeans/long pant options
Comfortable summer clothing
Sturdy sneaker, closed shoed or hiking boots while working with children
Flip flop or sandal for end of day
Long sleeve cotton shirt options
Hat/cap/sun visor (Sun is SCORCHING)
Modest Swimwear
Water Shoes
Safety
1-2 Flashlight
Batteries
Water Shoes
First Aid Kit
Sunscreen/block
Aloe Vera Gel/baby oil
Misc
Disposable Camera
Plan to pack personal items in carry on. Bring Camcorders and Digital Cameras at your own risk and expense. Leave valuable and sentimental items at home.