I am voluntarily providing personal information and medical history. I authorize Hamoreh, within one (1) yearof this date, to obtain any or all records and information concerning me regardless of whether the records and information are confidential. The release of files/records and information may include, but is not limited to, arrest records, training files, criminal files, employment records, personnel files, disciplinary records and/or performance evaluations.

If selected, I wish to participate in training and travel in Hamoreh Ministries’ ministry program. I am aware there are risks associated with international travel and service. I will at all times remain fully responsible for myself and my safety and health. I understand Hamoreh does not offer medical services, evacuation services, or legal advice. My service may include all manner of forseeable and unforeseeable risks such as strenuous activities, political unrest or danger, travel delays, hazards of being in undeveloped areas, and risks that third parties will not take appropriate safety precautions, among others. I take full responsibility for all my choices, actions and decisions. I will be responsible for my own immunizations and protective measures and I will not look to Hamoreh for health or safety advice or resources.

To the extent allowable by law, I assume any and all risks in illness, injury or death arising from my activities relating to Hamoreh and waive and release any and all actions, claims, suits or demands of any kind or nature whatsoever against Hamoreh Ministries, its contractors, vendors, officers, agents, directors, sponsors, volunteers or representatives of any kind (together “Released Parties”) arising from or relating in any way to my voluntary participation in this ministry. I understand that this Assumption of Risk, Waiver, Release and Indemnification Agreement means, among other things, that if I fall ill, am injured or die as a result of my participation, I and/or my family or heirs cannot under any circumstances sue any of the Released Parties for damages relating to or caused by my illness, injuries or death.

I agree to indemnify Released Parties and each of them and their subrogees if any, in the event of any loss, damage or claim arising from or relating to my service with Hamoreh Ministries. I understand and agree that I would not have been permitted to participate in this ministry had I not executed this Assumption of Risk, Waiver, Release and Indemnification Agreement.

Hamoreh sometimes photographs or films its participants. These images may be used on websites or marketing materials, displayed at events or officers, or used in other ways. I understand and agree that Hamoreh may photograph and videotape me and use my name and photographic likeness in all forms and media for any lawful purposes.

I have read this Assumption of Risk, Waiver, Release and Indemnification Agreement, have asked and received answers to any questions I had concerning its meaning, and execute it freely, without duress, and in full complete understanding of its legal effect, and of the fact that it affects my legal rights. I certify that all of my answers in this Application are true and complete.

This Notice of Privacy Practices describes how protected health information may be used or disclosed by us to carry out our training and operations, and for other purposes that are permitted or required by law. This Notice also sets out our legal obligations concerning your protected health information, and describes your rights to access and control your protected health information.

Protected health information (“Personal Data”) is individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health plan, your employer (when functioning on behalf of the group health plan), or a health care clearinghouse and that relates to: (i) your past, present, or future physical or mental health or condition; (ii) the provision of health care to you; or (iii) the past, present, or future payment for the provision of health care to you.

This Notice of Privacy Practices has been drafted to be consistent with what is known as the “HIPAA Privacy Rule,” and any of the terms not defined in this Notice should have the same meaning as they have in the HIPAA Privacy Rule.

EFFECTIVE DATE: This Notice of Privacy Practices becomes effective on February 6, 2014.

We strive to comply with the laws of the countries in which we do business regarding the protection of your Personal Data and we adhere to the following principles for handling your Personal Data:

1. Notice : We collect Personal Data from you including information: (i) from forms, such as this application; or in person, by telephone, website, email or correspondence; (ii) that is necessary or relevant to our application and training process; (iii) regarding your travels and service with us or others; or (iv) you provide to us or authorize us to collect from others. We collect your Personal Data: (i) to consider you for training; (ii) to plan and implement your travel and personal needs; or (iii) for purposes to which you’ve otherwise consented. If we collect your Personal Data for any other reason, we’ll notify you before using or disclosing that data, stating our purpose for collecting and using the data, the types of non-agent third parties to which we disclose the data, and the means we offer you to limit the use and disclosure of the data. This Policy reflects our business practices and is not a contract. We may amend this Policy at any time and will notify you of any updates. The revised policy will apply to all information collected by us, including previously collected information.
2. Choice . Except as required by law, we do not sell or disclose your Personal Data to non-agent third parties or use it for any purpose other than for which it was originally collected or as you authorize. If we wish to disclose your Personal Data to a non-Agent third party or use data for a purpose other than for which it was originally collected or as you authorize, we will provide you the affirmative, explicit choice of whether you wish to permit such disclosure. Though we make every effort to preserve your privacy, we may need to disclose Personal Data or Sensitive Data if we have a good-faith belief that it is necessary to (a) protect or defend our or your rights, interests or property; or (b) comply with any applicable law, regulation, judicial rule or order, or other mandate. In any such case, we will take reasonable care to disclose only as much Personal Data as is necessary.
3. Onward Transfer . We may disclose your Personal Data to people or organizations who perform tasks for us, but only for the above-stated purposes. We will take reasonable steps to obtain assurances from them that they will safeguard your Personal Data consistent with this Policy. Upon discovery, we will take reasonable steps to stop such persons or entities from using or disclosing Personal Data that is contrary to this Policy.
4. Security . We take reasonable precautions to protect your data from loss, misuse, or unauthorized access, disclosure, alteration and destruction. To help maintain the security of your data, we employ physical, electronic and procedural safeguards, including utilizing policies to take reasonable precautions to (a) securely and confidentially maintain your Personal Data; (b) protect against threats/hazards to the security or integrity of such data; and (c) prevent unauthorized access to or use of such data.
5. Access . If you discover that the data we hold about you is inaccurate or incomplete, please let us know. We will grant you reasonable access to the Personal Data we hold about you and will take reasonable steps to allow you to correct, amend or delete your Personal Data that you show to be inaccurate or incomplete, so long as it can be done without imposing an undue burden or expense on us.
6. Enforcement . Any complaint or dispute about how we handle your Personal Data should be directed to the address provided below. Additionally, complaints about how we handle your Personal Data may be directed to us or to the U.S. Secretary of Health and Human Services. We will investigate and attempt to resolve any such complaints or disputes internally. You will not be retaliated against for filing a complaint.