Waiver and Release of Liability Assumption of Risk and Indemnity Agreement – Impact Clean Water

1.         Mr. [volunteerName] hereinafter referred to as the “Volunteer” acknowledges that traveling to Honduras and participating in social service projects with Impact Water Inc. or any other organization or entity will be carried out without any responsibility whatsoever to Impact Water Inc., its officers, directors, managers, employees and/or legal representatives including, without limitation, Mark F. Smith (such parties collectively referred to as “Impact”). In consideration of Impact Water Inc. allowing me to participate in building the Water Project in Honduras; I, for myself, and on behalf of my spouse, children, parents, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the following contractual representations pursuant to this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement (the “Agreement”).  I hereby represent that I am in good health and in proper physical condition to participate in building the Water Project in Honduras agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the building of the Water Project.

2.         Assumption of the Risks.  Volunteer is aware and acknowledges that performing volunteer social service projects with Impact Water Inc. may subject Volunteer to a number of risks, including the risks of injury, illness, or death.  Volunteer understands and acknowledges that the risks include, without limitation: risks involved in transportation to, from, and within Honduras; risks that adequate medical facilities may not be available should the Volunteer require medical attention; and, risks of residing in and being subject to the laws of a foreign country. Volunteer is aware of the conditions that presently exist in Honduras, specifically, but not limited to, social unrest, security concerns, unsanitary health conditions in camps, villages, and municipalities, and the prevalence of hepatitis, malaria, cholera, dengue, and other diseases.   Volunteer hereby assumes all of the risks associated with participating in social service projects in Honduras.

3.             General Release.  Volunteer hereby releases and forever discharges Impact Water Inc. from any and all claims and demands of whatever kind or nature, whether known or unknown, which arise out of or are connected in any way whatsoever with Volunteer’s travel to and stay in Honduras and Volunteer’s voluntary participation in the work of Impact Water Inc. or any other organization.  Impact Water Inc. shall not be liable for any personal injury, loss of life, property damage, accident, delay, inconvenience, change in itinerary or accommodations, or other irregularity that may occur for any reason, including due to: (1) wrongful, negligent or arbitrary acts or omissions by any third party or authority; and (2) without limitation, Acts of God, fire, acts of governments or other authorities, wars, civil disturbances, riots, strikes, thefts, pilferage, epidemics, quarantines or dangers incident to the sea, land and air. Further, volunteer understands that by signing this release they are expressly releasing IMPACT, FROM ANY NEGLIGENCE OR GROSS NEGLIGENCE committed by IMPACT that results in any bodily injury or monetary loss to volunteer.

4.         Release Relating to Medical Treatment.  Volunteer hereby releases and forever discharges Impact Water Inc. from any and all claims and demands of whatever kind or nature, whether known or unknown, that arise out of or are connected in any way to first aid, medical treatment or medical services rendered to Volunteer in the course of the trip to Honduras or in any way related to the activities of Impact Water Inc.

5.         Volunteer’s Responsibility.  It is Volunteer’s responsibility to obey all local and international laws.  Impact Water Inc. does not condone any type of illegal activity. Volunteer has the sole responsibility of providing required documentation to federal and local authorities.  Required documentation may include, without limitation, passport, visa, travel itinerary, photos and similar type documents. The decision to obtain any vaccinations, medications, or other preventions prior to travelling to Honduras is the sole responsibility of Volunteer.

6.         No Insurance or Other Employment Benefit.  Volunteer understands and acknowledges that Volunteer is not an employee of Impact Water Inc.  Volunteer understands and agrees that Impact Water Inc. is under no obligation to provide, and will not provide, workers compensation, malpractice insurance, or any employee benefit of any kind whatsoever. In addition, Impact Water Inc. will not provide travel insurance, accident insurance, death insurance or insurance of any kind.  Insurance coverage is the sole responsibility of the Volunteer.

7.         Binding Effect.  Volunteer understands and acknowledges that this is a legal and binding document that affects Volunteer’s legal rights and remedies.  Volunteer agrees that the obligations herein shall be binding upon Volunteer personally, as well as its heirs, executors and administrators, and members of its family.

8.         Governing Law/Forum.        This Release of Liability & Assumption of Risk shall be governed by and interpreted in accordance with the laws of the State of Texas. In the event of any claim or legal action against Impact Water Inc., Volunteer agrees that the claim or legal action will be filed in the State of Texas, and hereby waives any right it may have to commence any litigation, administrative action or arbitration relating to Volunteer’s travel and stay in Honduras or participation in the work of Impact Water Inc. in any jurisdiction other that the State of Texas.

9.         I, the Volunteer, hereby certify that I have read all of the above and fully understand its content. I agree to hold Impact Water Inc. harmless for any accidents, claims, losses, damages or liabilities, including death, disability, injury that might occur. I expressly assume any and all risks with respect to the activities and circumstances described herein, and pledge not to sue Impact Water Inc. on account of any losses, claims, costs, liabilities or damages.  I agree not to claim the unenforceability of this Release.