Loading...

Office: 211 Townepark Circle | Suite 201 | Louisville, KY 40243

Giving: PO Box 660367 | Dallas, TX 75266

Phone: (502) 749-7691 | Fax: (866) LIA-3336

www.lifeinabundance.org | @LIAINT

Participant or Parent/Gaurdian ensures that all information included herein is current and to the best of their knowledge. Any missing elements from this packet may preclude participation from serving alongside of LIA. All minor participants (under the age of 18) will require an adult to complete the participant waiver.

PRINT VERSION: A printable version can be found at bit.ly/liatripwaiver.  ALL hand filled documents must be submitted by email to trips@lifeinabundance.org. 

**Life In Abundance International will not rent, sell or share any of your personal information.**

ASSUMPTION OF RISK AND RELEASE OF LIABILITY AGREEMENT

Purpose.  I agree, by my own free will, decision and initiative, to participate, travel and undertake other related activities (“Activities”) at locations to be determined by Life In Abundance International (LIA), a non-profit association, in various parts of the world.

Acceptance of Risk.  I am aware that the Activities may be HAZARDOUS AND ENTAIL NUMEROUS RISKS.  Accordingly, I have read and understood the United States Department of State travel warning provided by LIA pertaining to my destination of travel. I am voluntarily participating in the Activities.  These Activities include (but are not limited to) visiting facilities with or on behalf of LIA, visiting countries and facilities in countries that may have forms of civil unrest and violence, and traveling by any means in visiting foreign countries and other related Activities.  I understand the danger involved in such Activities and participate with the knowledge that medical facilities may not be available in the event I become ill or injured.  Thus, I agree to accept any and all risks of injury, illness, or death, and verify this statement.

Release.  In exchange for being permitted by LIA to participate in these Activities, I agree that I, my heirs, personal representatives, and assigns, will not make a claim against LIA or its directors, officers, agents, employees, volunteers, suppliers, contractors, subcontractors, or attorneys (the “Released Parties”) for injuries, illnesses or damages resulting from the negligent, reckless, or omissions of the Released Parties.  I release the Released Parties from all actions, claims, or demands that I, my heirs, personal representatives, or assigns now have or may have in the future for injuries, damages or death resulting from my participation in any LIA Activities.

Indemnity.  I agree to indemnify and hold harmless the Released Parties from any and all loss, liability, claims, damages, costs and expenses (including attorneys’ fees) resulting from or relating to, in whole or in part, my participation as a volunteer in LIA Activities.

Additional Release.  I transfer to LIA all rights, title and interest I may have in any and all photographic images, video or audio recordings, interviews, and other written, visual or broadcast media made, originated or created by LIA or its agents or employees during or in connection with LIA’s Activities, including (but not limited to) any royalties, proceeds, or other benefits derived from such materials.

Comprehension and Appreciation.  I have carefully read this Assumption of Risk and Release of Liability Agreement and I fully understand its contents.  I am aware that this is a legal contract between LIA and me and that it affects my legal rights.  I also understand that by releasing LIA from liability, I am giving up certain rights that I would otherwise retain.  I acknowledge that I have had the opportunity to review this document and to seek legal advice if I have any questions.

Insurance.  I understand that LIA does not maintain any form of insurance, including but not limited to health, life, liability, or for property loss, for me for any Activities.  In the event of injury, I will be responsible for all of my losses, costs, expenses, etc. To mitigate the impact of such a loss, I have obtained the recommended travel insurance for the duration of my trip.

Intent of Agreement.  I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of California and that this Agreement shall be governed by and interpreted in accordance with the laws of the State of California.

Arbitration.  In the event of any claim or dispute relating to this Agreement or any of the Activities or other matters described in the Agreement, I agree that such disputes shall be settled by binding arbitration in California, in accordance with the rules then prevailing of the American Arbitration Association, in lieu and instead of a jury trial.

Entire Agreement.  This Agreement embodies the entire agreement and understanding between LIA and me.  This Agreement may not be changed, waived, discharged, or terminated unless agreed to in writing by LIA and me.

Severability.  I agree that in the event that any clause, sentence, or provision of this Agreement shall be held to be invalid by any court of competent jurisdiction, the validity of that clause or provision shall not otherwise affect the remaining provisions of this Agreement which shall continue to be enforceable.

 

This Agreement is binding upon me and my heirs, personal representatives, and assigns, and any other person making a claim on my behalf.  In addition, if I am a married person or have another legally recognized partner, I agree that this Agreement is made by me on my behalf and on behalf of the marital community of my spouse and me, and I agree that this Agreement will be binding on that marital community or, in the event of a legally recognized partner, the same will apply. 

 

PARTICIPANT COVENANT

On behalf of the Life In Abundance International (LIA) family, we are honored that you would sacrifice your time and resources to engage with us at the community level.  Anytime we enter into a different cultural context, it is important to be mindful that we are guests in a country where the people have different norms and values and where situations and circumstances can be very different from those at home.  In an effort to fully honor the culture, the people, and the local church in the communities in which LIA works, please submit to local leadership and allow yourself to be aware of the areas where you can be culturally sensitive.  There will be many things that we do not understand — it is best to watch, listen, and learn.  We are not there to advocate or introduce Western values or methods, therefore we must do everything we can to respect and help preserve their traditions and culture. In doing so, please adhere to the following guidelines.

  1. I will keep my character above reproach in conduct and courtesy to maintain credibility of my Christian witness and to bring glory and honor to Christ in all that I do and say. 
  2. I will be an encouragement to my brothers and sisters in Christ both within the team and/or with those on the field.
  3. I agree that, unless specifically instructed otherwise, no community and/or field engagement will be done alone but with fellow team members and at least one LIA staff member. 
  4. I will submit to those who have been given authority over me at all times and understand that if I act in a way that is dishonoring to the name of Christ and/or to the leadership that I am under, I could be dismissed from the trip.
  5. I agree to have a servant's attitude at all times, regarding the needs and priorities of others as more important than my own.
  6. I will refrain from any consumption of alcohol, illegal substances or tobacco products and will refrain from the abuse of prescription drugs.
  7. I will commit to having a flexible, teachable and humble spirit throughout the trip in effort to grow as a disciple of Jesus Christ and to bring glory to His name.
  8. I will continue to have a consistent time with the Lord while on the field to encourage personal spiritual growth and a deeper relationship with Him.
  9. I will commit to exercising self-control in my use of the internet, social media, phone, text messaging etc., that I may be fully present during the course of the trip.
  10. I will refrain from being alone with the opposite gender, unless with a spouse, at all times.
  11. I agree to exercise wisdom and resist any activities, interactions, and relationships that could take my focus from the intent of the trip. 

I understand that if my decisions or conduct do not align with the above statements, LIA leadership has the authority to take disciplinary action accordingly. 

 

SMART TRAVELER ENROLLMENT PROGRAM (STEP) REGISTRATION

LIA strongly recommends that all citizens partnering with us register their trip through the Smart Traveler Enrollment Program (STEP). This will alert in-country U.S. embassy offices of your travel plans and your general location in the event of an emergency, natural disaster, or civil unrest. It also will allow you to receive important information from the embassy regarding the country being visited.

You can register your trip online by visiting: step.state.gov.

 

TRIP RESOURCES

Find available resources to assist you in preparation for your trip by visiting www.lifeinabundance.org/trips.

Questions? Contact us at trips@lifeinabundance.org

Please select who will be participating:
AdultMinor
Continue
First Participant Name

First Name*

Last Name*

Phone*
First Participant Date of Birth*
First Participant Signature*
Participant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent / Guardian Email Address

Email*

Confirm Email*
Check to give permission for LIA to contact you with pre-trip resources, post-trip follow-up and/or prayer & general updates.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Trip Information
Trip Destination:*

Trip Leader Name (if applicable):

Trip Co-Leader Name (if applicable):

Trip Start Date: *

Trip End Date: *

Church / Organization: *
Passport Information

NOTE: The U.S. Department of State recommends passports have at least six months of validity-beyond your actual travel date-to avoid expensive and lengthy travel disruptions.

Do you have a valid passport? *
Yes
No, but application has been submitted
No

Passport Number (leave blank if none):

Issuing Authority:

Date of Issue (leave blank if none):

Date of Expiration (leave blank if none):
Medical / Allergy Information
Do you have ANY known medical conditions that may affect your trip?*
Yes
No

IF YES, please list ALL known medical conditions (leave blank if none):
Do you have ANY known non-food allergies that may affect your trip?*
Yes
No

IF YES, please list ALL known non-food allergies (leave blank if none):
Do you take ANY prescription medication(s)?*
Yes
No

IF YES, please list ALL prescription medication(s) that you take (leave blank if none):
Food Allergy / Diet Information
Do you have ANY known food allergies that may affect your trip?*
Yes
No

IF YES, please list ALL known food allergies (leave blank if none):
Do you have ANY dietary restrictions that may affect your trip?*
Yes
No

IF YES, please list ALL known dietary restrictions (leave blank if none):
Participant Bodyweight

NOTE: Requested due to the requirements of many in-country airlines to provide accurate passenger bodyweight in advance.


Bodyweight (lbs.): *
Previous Experience with LIA
Have you participated in a trip with LIA before?*
Yes
No

IF YES, where and when? (leave blank if none)?
Participant Information
Are you currently a student? *
Not a student
High School Student
College Student
Other

Current Occupation / Job: *

Please list your previous ministry experience: *

What are your specific interests in ministry and missions? *

Please list any personal gifts or talents that you may have: *
Additional Information

Please use the below section to let us know of any information which may be important that was not covered above (leave blank if none):
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent / Guardian Name

First Name*

Last Name*

Relationship*

Phone*
Parent / Guardian Date of Birth*
Parent / Guardian 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!