Deadline for submission of the form below is October 31, 2024. If you have any questions,
please contact Fil (201-841-5472) or Hum Flores (201-390-6013) or email
[email protected] or [email protected]

BLD NEWARK MEDICAL MISSION
Morong, Bataan, Philippines
February 17- 20, 2025

VOLUNTEER SIGN-UP SHEET
 
Please note:

Each volunteer is required to register individually to ensure accurate accounting and assignment. Our profound gratitude is extended to the medical professionals and 4-day volunteers, and priority will be granted to them on a first come-first-served basis.

Accommodation and Transportation
Information regarding hotel accommodation and transportation will be provided as it becomes available.

A group bus transportation service will be arranged from a specified location in Metro Manila to the venue on February 16, 2025 (Sunday) and for the return journey on February 21, 2025 (Friday). To indicate your intention to use the group bus transportation on February 16, 2025, and/or February 21, 2025, please select the appropriate options below. 

Once the arrangements are finalized, we will communicate the designated place in Metro Manila, departure and estimated arrival times, as well as the associated costs.

For any questions, please feel free to contact: Fil and Hum Flores:

    *** PLEASE FILL OUT ONE FORM PER PERSON***
    Note: Please indicate "NA" if you will not be staying at the hotel.



    WAIVER AND RELEASE

    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 17-20, 2025 at Morong Batan, 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.
    NOTE: Please ensure that you answer all required questions indicated by RED asterisk. Incomplete forms will not be forwarded to the Medical Mission Ministry