THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISKS (the "Release") is executed by______________________________
whose address is _____________________________________________________________________________________________________________
in favor of THE GLOBAL AWARENESS INSTITUTE, INC., a Florida not for profit corporation, and DR. BARBARA BRODMAN, owner of lands in Peru leased to GAI (�GAI�), whose address is 2208 S.E. 20th Street, Fort Lauderdale, FL 33316.
1. PARTICIPATION IN THE TRIP. I am a student at __________________ University. I desire to participate in a trip to Peru, scheduled to occur between _______, 20__ and _______, 20__ for the primary purpose of participating in a tropical medicinal plant workshop (the "Trip"). I understand that I am not required to attend the workshop and I am doing so on a purely voluntary basis.
2. WAIVER OF GAI LIABILITY FOR DANGERS AND RISKS. I understand that there are certain dangers, hazards, and risks inherent in international travel and the activities to be engaged in during the Trip including, but not limited to, those set forth in exhibit " A " attached hereto and made a part hereof, which can cause personal injury, death and/or property damage. I further understand that GAI cannot and does not assume responsibility for any such personal injury, death or property damage.
3. ASSUMPTION OF RISKS. Notwithstanding the dangers, hazards, and risks involved, and in consideration of being permitted to participate in the Trip:
(i) I agree to assume all the risks surrounding my participation in the Trip and in the activities I undertake in connection therewith, including the elective trip to Cuzco/Machu Picchu, ________, 20__; and
(ii) I release and forever discharge GAI, its Board of Directors, officers, agents, employees, and lessor of lands leased by GAI (hereafter collectively called the "Releasees") from any and all liability for any injury, damage, claim, demand, action, cost, and expense of any nature that I may at any time have or incur, arising out of or in any manner related to any loss, damage, or injury, including but not limited to suffering and death, that may be sustained by me or by any property belonging to me, while in Peru or in transit to and from Peru.
4. DISCLAIMER OF GAI RESPONSIBILITY. I understand and agree that GAI is
(i) not responsible or liable for any injury , damage, loss, accident or delay which may be caused by a defect in any vehicle or other mode of transportation, or the negligence or other wrongful act of any party engaged to provide services connected with the Trip.
(ii) not responsible or liable for any injury , damage, loss, accident or delay which may be caused by a defect in any vehicle or other mode of transportation, or the negligence or other wrongful act of any party engaged to provide services connected with the Trip.
(iii) not responsible or liable for disruption of travel arrangements, or any consequent additional expenses that may be incurred therefrom, and
(iv) not responsible or liable for any loss, damage, or theft of my luggage or other personal belongings.
5. RESPONSIBILITY FOR MEDICAL NEEDS. I represent to GAI that I am aware of my personal medical needs and that there are no health-related reasons or problems which preclude or restrict my participation in the Trip. I acknowledge that GAI has required that I obtain insurance coverage valid in Peru to protect against the cost of hospitalization and physician care in the event of sickness, accident, injury and disability. I understand that I am solely responsible for obtaining such insurance. I further understand and agree that (i) GAI is not responsible for attending to any of my medical or medication needs, (ii) I assume all risks and responsibility for my medical or medication needs, and (iii) if I am required to be hospitalized at any time during the Trip, GAI does not assume any legal responsibility for payment of such costs.
6. EMERGENCY MEDICAL TREATMENT. I understand that the Releasees do not have medical personnel available at any time during the Trip. I grant the Releasees permission to authorize emergency medical treatment, including surgery, and I agree that such action by the Releasees shall be subject to the terms of this Release. I understand and agree that the Releasees assume no liability or responsibility for an injury or damage which might arise out of or in connection with such authorized emergency medical treatment.
7. LEGAL PROBLEMS. I understand that if I have a legal problem in Peru during the Trip, I will attend to the matter personally with my own funds and that GAl is not responsible for providing any assistance to me under such circumstances.
8. BINDING NATURE OF RELEASES. It is my express intent that this Release shall bind the members of my family (including my spouse, if any) if I am alive, and my heirs, personal representatives, successors, and assigns if I am deceased.
9. INDEMNIFICATION. I agree to indemnify, defend and hold the Releasees harmless from any liability, claim, action, debt, damage, loss, cost and expense of every kind or nature asserted by any party against any Releasee or incurred by any Releasee and arising directly or indirectly from or in connection with my participation in the Trip or any of the activities I engage in during the Trip.
10. RESERVATION OF RIGHTS. I acknowledge that GAI reserves the following rights that it may exercise in its sole discretion: (i) the right to cancel the Trip, and (ii) the right to make alterations, changes, and modifications in any part of the Trip itinerary and the activities in connection therewith.
11. PASSPORT , VISA AND VACCINATIONS. I understand that I am responsible for obtaining my own passport, visa, and public health vaccinations.
12. COMPLIANCE WITH LAWS. I agree to comply with all laws of Peru during the trip.
13. DISCLOSURE. GAI HAS INFORMED ME THAT BY SIGNING THIS DOCUMENT I RELEASE AND WAIVE CERTAIN LEGAL RIGHTS THAT I OTHERWISE MIGHT HAVE, AND THAT I SHOULD READ THE DOCUMENT CAREFULLY AND UNDERSTAND IT FULLY BEFORE SIGNING.
14. REPRESENTATIONS. I represent to GAI that (i) I have read this Release and fully understand its contents and the effect of its terms and provisions, (ii) I sign this release as my own free act and deed, (iii) with respect to the matters set forth in this Release, no oral representations, statements or inducements other than those expressly contained herein have been made to me by any of the Releasees, (iv) I am over eighteen (18) years of age and fully competent to sign this Release, and (v) I execute this Release for complete and adequate consideration, fully intending to be bound by the same.
15. GOVERNING LAW. I agree that this Release shall be construed in accordance with the laws of the State of Florida.
16. PARTIAL INVALIDITY. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, then I agree that the validity of all remaining terms and provisions shall not be affected thereby.
IN WITNESS WHEREOF, I have executed this Release of Liability and Assumption of Risks on this____ day of____________, 20__.
WITNESSES: STUDENT:
______________________________ ___________________________
Signature Signature
______________________________ ___________________________
Printed Name Printed Name
______________________________
Signature
______________________________
Printed Name
Exhibit �A�
PROBLEMS and hazards that participants can experience:
1. Poor quality food or drinking water.
2. Food poisoning.
3. Circumstances of travel via plane, canoe or local transport.
4. Pick pockets, or theft at hotel or elsewhere during trip.
5. Sexual harassment and unwarranted sexual advances.
6. Natural events, e.g. earthquakes, tropical storms, volcanic activity, etc.
7. High altitude nausea, nose bleeds, headaches.
8. Drug availability and severe police/legal penalties.
9. Possible political instability.
10. Kidnapping, torture and death.
11. Guerrilla warfare.
12. Drug cartel violence.
13. Terrorist activity of any kind.
14. And any other unforeseen circumstance that can cause problems, permanent damage or even death.