2027 October 2-9 Gen/GYN Trip Registration
  • Trip Registration

  • Personal Information

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  • Format: (000) 000-0000.
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  • Format: (000) 000-0000.
  • Many risks are inherent while traveling to Guatemala, even for the healthiest of volunteers. (See“HTI Trip Policies” and “Disclaimer and Assumption of Risk and Release” documents below.) The purpose of this survey is to identify specific health risks that could impact the Volunteer while serving with HTI in Guatemala. This list should in no way be perceived as exclusive. If you have any of the following conditions you are advised to speak with your Physician about traveling to Guatemala. Specifically, as you are filling out this form ask yourself: am I comfortable with being three (3) hours away from the nearest Guatemalan hospital?  Please also remember to bring with you all medications (prescription or over the counter) required for the maintenance of your health in an amount that will last you for at least a week. There are limited resources for specific medications in Guatemala. The content of this questionnaire will be collected by HTI and may be used for your care in the event of a medical emergency pursuant to the Power of Attorney you may consent to hereafter. Note that if you select any of the following items this does not mean that you are disqualified from going on this Trip.

    Medical Status Questionnaire


    ___ Strokes
    ___ Seizures
    ___ Severe or uncontrolled hypertension
    __ Diabetes
    __ Cardiac Disease with pacemaker, previous cardiac stent placement, previous           cardiac arterial bypass
         surgery, valve replacement, pacemaker, or other significant cardiac history
    __ Recent episodes of chest pain
    __ Conditions necessitating blood thinners or anti-coagulation
    __ Kidney or liver failure
    __ COPD
    __ Asthma (severe)
    __ Previous history of anaphylactic reaction or severe allergic response
    __ Pregnancy
    __ Current presence of known Gall Stones
    __ Venous disease
    __ Arterial Insufficiency
    __ Psychosis or hallucinations

     

     

    HIPPA

    In the event medical history or status is gained from Volunteer, voluntarily to HTI or the agents identified hereinabove, via the “Medical Status Questionnaire” or another source, and in the event said information is deemed “Protected Health Care Information”, my Agent will be my personal representative for all purposes of federal or state law related to privacy of medical records (including the Health Insurance Portability and Accountability Act of 1996) and can disclose the contents of my medical history, status, or records to others for my ongoing health care.  Furthermore, in the event of breach of any healthcare related information given by me voluntarily to HTI and in consideration of HTI’s increased ability to proactively respond to my healthcare related emergency, I hereby defend, hold harmless, indemnify and release and forever discharge Health Talents International, Inc., and all its officers, agents and employees from and against any and all claims, demands and actions, or causes of action, on account specifically of such breach.

     

    WHEREAS, this agency shall terminate when the duly authorized United States Healthcare Agent or next of kin of Volunteer demands that this Agency terminate or otherwise presents themselves in the Country of Guatemala.

     

    IN WITNESS WHEREOF, I have caused this Release and Power of Attorney to be executed on the day of my registration for Mission Trip upon the submission of my reservation form and signing of this document.

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  • Room and Board

  • Flight and Transportation Planning

  • Departing: Many volunteers choose to arrive in Guatemala City on Friday, as it helps break up the travel and can make the journey less stressful, particularly if there are flight delays.

    HTI trip leaders will be in Guatemala City that evening. This option adds $75 per person to your trip cost and includes a hotel stay and breakfast on Saturday morning.

    We understand that not everyone is able to travel on Friday.

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  • International Volunteer Release of Liability

  • By signing below, I agree to all of the terms and conditions of this Release of Claims and Waiver of Liability (referred to below as “Release”).

    I understand that “the Sponsors” as used in this Release refers, individually and collectively, to the following organizations and persons: Health Talents International, Inc. (“HTI”), a nonprofit corporation organized under the laws of the State of Alabama, and all of its officers, employees, and agents; and Asociación Talentos de Salud Internacional (“TSI”), a nonprofit association organized under the laws of Guatemala, and all of its officers, employees, and agents.

    I understand that the Sponsors are providing an opportunity for volunteers to participate in Christian medical evangelism, ministry, and missionary services as described below. These services, including all travel and other activities in connection with them, are referred to in this Release as “the HTI Program.”

    Description of the HTI Program:  The HTI Program involves volunteering to serve on a medical, surgical, or dental team, participating in the Medical Evangelism Training (MET) program, or participating in any area pertinent to the HTI Program.

    I desire to volunteer to participate in the HTI Program as a matter of personal spiritual growth and Christian service.  In order to induce the Sponsors to permit me to participate in the HTI Program, and in consideration of the opportunity provided by the Sponsors for me to participate in the HTI Program, I have read and signed this Release, fully intending to be legally bound by its terms.

    Assumption of All Risks.  I acknowledge that my participation in the HTI Program involves known and inherent risks, as well as unknown and unanticipated risks, which could result in my death, in serious physical or emotional injury, and in damage to or loss of my personal property. These risks include but are not limited to transportation accidents, criminal activity, exposure to illness or disease, terrorist activities, and situations which may result from different living conditions, climate, diet, water quality, pollution, and political instability.  Women frequently experience particular difficulties while traveling abroad, including sexual harassment and uncomfortable cultural expectations or stereotyping. 


    I understand that the U.S. Department of State publishes alerts and warnings relating to international travel on its website at: 


    http://travel.state.gov/content/passports/en/alertswarnings.html 


    I assume responsibility for reviewing the contents of these notices and keeping current with any changes which may be posted.


    I understand that all of the risks described in this Release are listed as examples and not as an exhaustive list of all of the potential hazards I may encounter during the HTI Program. I knowingly assume full responsibility for these risks.  I understand that the sponsors of the HTI Program will make reasonable efforts to respond to my health care and personal safety needs, but their ability to respond may be limited by the local conditions and circumstances.

    Status as a Volunteer.  I understand that I will be participating in the HTI Program as a volunteer and not as an employee, and that I will not receive any monetary payment or other compensation for any services which I may render.

    Insurance.  I understand that the only insurance the Sponsors provide is the TripArmor Travel Protection Post Departure Plan. I understand that the Sponsors do not assume any responsibility or obligation to provide additional financial or other assistance to me if I am injured while serving as a volunteer.  The Sponsors have no obligation to provide additional medical or health insurance, disability insurance, workers compensation coverage, or any other insurance to provide benefits or coverage to me if I suffer an injury, illness, death, or property damage while serving as a volunteer. 

    Waiver and Release. I release and forever discharge and hold harmless the Sponsors from any claim or liability that I may now or hereafter have against the Sponsors respect to any bodily injury, personal injury, illness, death or property damage arising out of my participation in the HTI Program.  I make this Release on my own behalf, as well as on behalf of my heirs, personal representatives, and any other person claiming through me.

    Agreement to Indemnify.  If I or any person acting on my behalf brings against a Sponsor any claim which I have waived or for which I have assumed the risk under this Release, I will indemnify and hold the Sponsors harmless from any cost or expense of any kind arising from such claim, including court costs and reasonable attorney’s fees.

    Medical Treatment.  I authorize the Sponsors to provide or arrange for first-aid or emergency treatment if I am injured or become ill while participating in the HTI Program.  I release and forever discharge the Sponsors from any claim whatsoever arising from such treatment.  The Sponsors shall have no duty or obligation to provide medical treatment to me, and I agree to assume the cost of any medical treatment which is provided for me, and for medical evacuation if that becomes necessary or advisable, if it is not covered by the TripArmor Travel Protection Post Departure Plan described above.

    Severability.  Every term and provision of this Release is intended to be severable. If any clause is found to be unenforceable or invalid, all of the other terms and provisions of this Release will remain binding and enforceable


    I have read this document carefully. I understand this Release is a legal document which limits or waives rights or claims of right which I might otherwise have.  I intend for this Release to be a general release of liability and for this Release to be interpreted as broadly as the law permits in favor of the Sponsors. 
     
    I have freely and voluntarily signed this Release below to indicate my agreement to its terms.


    **If the Volunteer is under 18years of age (or under 19 years of age if the Volunteer is a resident of Alabama or Nebraska, or under 21 years of age if the Volunteer is a resident of Mississippi), then a Parent or Guardian will need to sign the release form below. 

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