Volunteer Release and Disclaimer

THIS AGREEMENT is entered into by and between _____________________ (hereinafter referred to as "Releasor"), and
The Afghanistan Dental Relief Project, Inc., a California 501(c) Non-Profit corporation (hereinafter referred to as "Releasee"),
for and in consideration of the sum of One Dollar ($1.00), and other valuable consideration received from or on behalf of Releasee,
the receipt of which is hereby acknowledged, with reference to the following facts:

WHEREAS, Releasee provides and will be providing free or low cost dental care and dental training to persons residing in the nation of Afghanistan;

WHEREAS, Releasor wishes to act as an unpaid Volunteer to assist and aid Releasee in this humanitarian endeavor.

NOW THEREFORE,

• Releasor does hereby acknowledge that Afghanistan is an Islamic Republic which is subject to Sharia law, is currently a politically unstable environment and is currently on the U.S. State Department Travel Advisory Warning list.

• Releasor does hereby further acknowledge that at times or all the time it may be or may become physically unsafe to be or remain in Afghanistan during the period of time that Releasor acts as a Volunteer with Releasee.

• Releasor does hereby further acknowledge and agree that Releasor shall maintain a policy of health/accident insurance at all times that Releasor is engaging in Volunteer work for Releasee.

• Releasor does hereby remise, release, acquit, satisfy, and forever discharge the said Releasee, of and from all manner of actions, causes of action, and suits, including, but not limited to, any suit for personal injury or wrongful death, debts, costs, covenants, contracts, controversies, agreements, promises, claims and demands whatsoever, which said Releasor ever had, now has, or may have, and which any personal representative, successor, heir or assign of said Releasor, hereafter can, shall or may have, against said Releasee, by reason of any matter, cause or thing whatsoever in relation to the endeavors in Afghanistan of Releasee or Releasor, including, but not limited to, any activities in preparation for any journey to Afghanistan, whether in the U.S., or en route to or from Afghanistan, and any and all activities engaged in while in Afghanistan, whether or not such activities are on behalf of Releasor.

• This Agreement shall be effective on the date this instrument is executed by the parties hereto.
  

IN WITNESS WHEREOF, the said Releasor has hereunto set hand and seal this ____ day of ________________, 2005.


"RELEASOR"

___________________________

___________________________

Print Name

“RELEASEE”

The Afghanistan Dental Relief Project, Inc.

By: ___________________________

James Rolfe, D.D.S.

Its: ___________________________

STATE OF CALIFORNIA

COUNTY OF ______________

I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid, to take acknowledgments, personally appeared _________________ and _____________________ to me known to be the persons described in and who executed the foregoing instrument and acknowledged before me that it was executed for the purposes set out therein.

__________________________

My Commission Expires: ________________

Please access our website, www.adrpinc.org.

Thank you for your interest.
James G. Rolfe, DDS; Founder
Afghanistan Dental Relief Project, Inc.