MAMES, Volunteer Registration, Medical Mission in Myanmar
Myanmar Medical Mission, January 2020
Please register in this form if you are going to join Rural Outreach Program. Are you registering for the Rural Outreach Program?
Please choose one of the following
Doctor (Attending Physician)
Doctor (Fellow/ Resident/ Intern)
IT / Computer Specialist
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Volunteer Release and Waiver of Liability
This Release and Waiver of Liability (the “release”) executed by the signed volunteer releases The Myanmar American Medical Education Society, Inc. (MAMES), a nonprofit corporation organized and existing under the laws of the State of New York and each of its directors, officers, members, employees, and agents.
The Volunteer desires to provide volunteer services for MAMES and engage in activities related to serving as a volunteer. Volunteer understands that the scope of Volunteer’s relationship with MAMES is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that MAMES will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to MAMES.
1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless to MAMES and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to MAMES. I understand and acknowledge that this release discharges MAMES from any liability or claim that I may have against MAMES with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to MAMES or occurring while I am providing volunteer services.
2. Insurance: Further I understand that MAMES does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of MAMES beyond what may be offered freely by MAMES in the event of injury or medical expenses incurred by me.
3. Medical Treatment: I hereby release and forever discharge MAMES from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with MAMES.
4. Assumption of Risk: I understand that the services I provide to MAMES may include activities that may be hazardous to me including, but not limited to functions involving inherently dangerous activities. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and release MAMES from all liability.
5. Photographic Release: I grant and convey to MAMES all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by MAMES in connection with my providing volunteer services to MAMES.
6. Other: As a volunteer, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the State of New York and that this release shall be governed by and interpreted in accordance with the laws of the State of New York. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.
I agreed the Volunteer Release and Waiver of Liability. By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.
Signature (Full Name)
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