Do you agree to the statement below? *
If a medical emergency should arise for me during my visit to Nicaragua, I hereby give permission to a qualified medical physician and/or hospital to provide the appropriate care and to administer any emergency medical treatment, which may be required for me. I also hereby give such medical personnel and/or hospital my permission to any necessary examination, anesthesia, medical diagnosis, or treatment and/or hospital care to me. I understand AMOS Health and Hope and any representatives or missionaries cannot assume responsibility for medical expenses for me and I agree to bear such responsibility and pay any such expenses incurred with respect to such medical emergency.