Deadline for submission of the form below is October 31, 2025.
If you have any questions, please contact Fil and Hum Flores:
(Phone) 201-841-5472; (Email) [email protected] or [email protected]
BLD NEWARK MEDICAL MISSION
Sariaya, Quezon, Philippines
FEBRUARY 16 - 19, 2026
VOLUNTEER SIGN-UP SHEET
 
Please note:

Each volunteer is required to register individually to ensure accurate accounting and assignment. We wish to extend our sincere gratitude to the medical professionals and to those who commit to volunteering for a duration of four days. Priority will be granted to these individuals on a first-come, first-served basis.

Accommodation and Transportation
Information regarding hotel accommodations and transportation will be disseminated as it becomes available. A group bus transportation service will be arranged from a designated location in Metro Manila to the venue on February 15, 2026 (Sunday), with a return journey scheduled for February 20, 2026 (Friday). To indicate your intention to utilize the group bus transportation on either February 15, 2026, or February 20, 2026, please select the appropriate options below. Upon finalization of the arrangements, we will provide information regarding the specific pickup location in Metro Manila, as well as the departure and estimated arrival times and associated costs.

For any questions, please contact Fil and Hum Flores:

    *** PLEASE FILL OUT ONE FORM PER PERSON***
    **Attention: An Incomplete form cannot be successfully submitted! **
    Before you proceed, please make sure that all required fields above, marked with a red asterisk (*), are filled in, as leaving any of them blank will prevent successful submission.

    WAIVER AND RELEASE

    For and in consideration of my application and admission to participate in the coming Medical Mission to be held on or about Feb 16-19, 2026 at Sariaya, Quezon, Philippines, I hereby commit as for myself, my executors, administrators, heirs, next of kin, and assigns as follows:

    (A) FULL RESPONSIBILITY – As a volunteer I understand and assume full responsibility for the possible risk of bodily injury known or unknown, death or loss of property resulting from any incident/accident, including but not limited to kidnapping, assault, terroristic threats, and any illness or diseases which, while in the course of discharging my duties could occur as a result of participation in this Medical Mission.

    (B) WAIVE, RELEASE, AND DISCHARGE – I hereby waive, release and discharge from any and all liability, including but not limited to, any and all causes arising from commission or omission, negligence or fault of BLD Newark/ BLD Newark Foundation, its officers and members, for death, disability, personal injury, property loss or damage, or actions of any kind which may hereafter occur to me including payment of medical cost due to hospitalization, physicians’ bills, and transportation to and from the venue of this
    Medical Mission.

    (C) INDEMNITY, HOLD HARMLESS – I indemnify, hold harmless and promise not to sue the above-named organization or any persons acting in its behalf, or any persons mentioned above, from all liabilities or claims made as a result of participation in this Medical Mission. I acknowledge that the BLD Newark/ BLD Newark Foundation, its officers, members and volunteers are not responsible for the errors, omissions, acts, or failures to act of any party or organization conducting this Medical Mission.

    I hereby affix my signature to signify my complete understanding and full agreement to this Waiver and Release.