In the case your US based Insurance covers International Healthcare, include your information here

I understand that there are risks involved with travel and service including, but not limited to diseases, inadequate medical supplies/facilities, falls, accidents, use of tools, effects of weather, and/or potential hazards of criminal nature, political unrest, terrorism, or rioting . I assume full responsibility for any risk of bodily injury (including death), and/or ill health related to this trip. I release Mission Circle Inc and its Board of Directors, my home parish, my home diocese, our twinning partner parish/mission, our twinning partner diocese, our trip team, the Parish Twinning Program of the Americas, its staff and Board of Directors members from and against any and all claims, demands, causes of action, damages, costs, liabilities, fees, penalties, and expenses, including attorney's fees and costs, for any personal injury or damage to personal property arising out of or resulting from any actions, including misfeasance, malfeasance, negligence, or intentional act or omission of mine, with respect to this trip. I also understand that this Release binds me, my family, estate and/or heirs. I have read this Release. I fully understand it and agree to be legally bound by it.