I authorize a physician on this team to consent to any necessary examination, anesthetic, medical diagnosis, surgery, treatment and/or hospital care rendered to me and on the advice of any physician or surgeon licensed to practice medicine by the state and /or country in which they practice during the duration of the trip identified above. I attest my understanding and agreement by checking the box.

Volunteer and Guardian do hereby release and forever discharge Power of a Nickel, Inc. from any claim whatsoever which a rises or may hereafter arise on account of any first aid treatment or service rendered in connection with the Volunteer’s participation in mission work projects or with the decision by Power of a Nickel, Inc. or any representative or agent of to exercise the power to consent to medical or dental treatment as such power may be granted and authorized. I attest my understanding and agreement by checking the box.

The volunteer and Guardian understand that the work projects may include activities that may be hazardous to the Volunteer and that the food, accommodations, and medical facilities may be donated to Power of a Nickel, Inc. and beyond its control. I attest my understanding and agreement by checking the box.

Volunteer and/or Guardian do hereby release and forever discharge and hold harmless Power of a Nickel, Inc. and it’s 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 here after arise from Volunteer’s participation in mission work projects. Volunteer or Guardian may have with respect to bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s participation in mission work projects. Volunteer and Guardian also understand that Power of a Nickel, Inc. does not assume any responsibility for or obligation to provide financial assistance or other assistance including but not limited to medical, health, evacuation, or disability insurance. I attest my understanding and agreement by checking the box.

INSURANCE - The Volunteer and Guardian understand that Power of a Nickel, Inc. does not carry or maintain health, medical, evacuation, cancellation or disability insurance coverage. It is the Volunteer/Guardian's personal responsibility to check with your local insurance carrier about primary accident coverage for you while in transit and on-site at work projects. Each Volunteer is required to provide proof of evacuation insurance for international destinations. The Volunteer/Guardian is advised to obtain a policy for medical insurance. I attest my understanding and agreement by checking the box.

I bear full legal and financial responsibility for myself, including responsibility for all indebtedness or other legal obligations incurred by me while on this mission. I attest my understanding and agreement by checking the box.

At any time prior to or during the mission, Power of a Nickel, Inc. shall have the right to require my withdrawal from the mission if it is determined in Power of a Nickel’s sole discretion, that my ongoing participation may be detrimental to me, to others, or to Power of a Nickel, Inc. I attest my understanding and agreement by checking the box.

It is my responsibility to review information from the U.S State Department and CDC regarding the travel risks in the countries to which I will travel and to obtain appropriate immunizations and prophylactic medications prior to the mission trip. I attest my understanding and agreement by checking the box.

By participating in a Power of a Nickel Global Outreach Trip, I give Power of a Nickel the right to use my image in photo or video and my comments for publicity purposes related directly to the mission of Power of a Nickel. I understand that I will not be compensated should the images or comments be used in our media pieces. I attest my understanding and agreement by checking the box.

Volunteer and Guardian expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Oklahoma. Volunteer and Guardian agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which continue to be enforceable. I attest my understanding and agreement by checking the box.