TO VOLUNTEERS:

We are delighted with the opportunity of sponsoring your activities and helping you with some of the arrangements. We must warn you, however, that volunteers of Health Volunteers Overseas may be subject to considerable risks, including, but not limited to, the risks of international travel and terrorism. As our organization is comprised entirely of volunteers like yourself, it has limited funding and has no insurance to cover these risks. Each volunteer is expected to assume any and all risks that may result from his or her activities and to procure insurance coverage as he or she deems appropriate.

Please sign and date this document and return it to HVO acknowledging this notification, releasing us from liability, and indemnifying us from claims against us arising from your activities. We must receive a signed copy of this letter before we can continue to process your application. Thank you.

Sincerely,

Nancy A. Kelly, M.H.S.
Executive Director

The undersigned hereby acknowledges receiving this letter, and acknowledges
the risks assumed by volunteers of Health Volunteers Overseas. On behalf
of himself or herself and his or her family and personal representatives,
the undersigned hereby agrees to indemnify, release and forever discharge
Health Volunteers Overseas, its officers, directors, members and all other
persons and organizations working on its behalf from any and all loss,
liability, actions, claims and demands of any nature, past, present or future,
that may result from or be in any way related to the undersigned's activities
conducted under the auspices of Health Volunteers Overseas.

NAME:______________________________________________________________________ (PLEASE PRINT)

SIGNATURE:_________________________________________________________________

DATE SIGNED:_______________________________________________________________

PROGRAM & COUNTRY OF ASSIGNMENT:
_______________________________________________________________

DATE OF DEPARTURE FOR SITE:
___________________________________________________________________________

DATE OF RETURN HOME:
___________________________________________________________________________

Please print this form out, sign and return it to HVO. You may fax it to our
office - (202)296-8018 or you may put it in the mail. Please use our street address:

Health Volunteers Overseas
1900 L Street, NW
Suite 310
Washington, DC 20036