{"content":[{"text":"from participation with them and will be responsible to make alternate lodging and \n transportation arrangements, at my own expense.","bbox":{"left":0.147059,"top":0.090755,"width":0.695967,"height":0.035641000000000006}},{"text":"I consent to the use of any video images, photographs, audio recordings or any other \n visual or audio reproduction that may be taken of subject of this release while in \n Haiti to be used, distributed or shown as Help Us Save Us , Inc sees fit.","bbox":{"left":0.147059,"top":0.138936,"width":0.703727,"height":0.05321799999999999}},{"text":"I am aware of the recommendations of Help Us Save Us, Inc. regarding seeking a \n physician’s approval of good health appropriate for travel to Haiti, Tetanus \n shots/boosters, Hepatitis A vaccinations, Hepatitis B vaccinations and preventative \n medications for Typhoid and Malaria. The undersigned acknowledges personal \n responsibility to choose whether to follow these recommendations and agrees to \n hold harmless and indemnify Help Us Save Us, Inc. in the event of the development \n of any disease or any other health problems incurred by the subject of this release \n while in Haiti.","bbox":{"left":0.147059,"top":0.204694,"width":0.6932449999999999,"height":0.14230800000000005}},{"text":"Signature _____________________________________","bbox":{"left":0.147059,"top":0.389846,"width":0.35333699999999996,"height":0.017762999999999973}},{"text":"Date ________________________________","bbox":{"left":0.526281,"top":0.389846,"width":0.27527900000000005,"height":0.017762999999999973}},{"text":"The undersigned consents to the admission of medical intervention, including but \n not limited to first aid, hospitalization, injections, anesthesia, surgery or any form of \n medical treatment necessitated by illness or injury that may require the same. In the \n event of the necessity of such care or treatment as heretofore described, the \n undersigned agrees to hold harmless and indemnify said Help Us Save Us , Inc., its \n directors, employees and agents from any acts of malfeasance, and/or failure to act \n on the part of those chosen to administer medical care on the behalf of the \n participant.","bbox":{"left":0.147059,"top":0.481058,"width":0.7041820000000001,"height":0.142308}},{"text":"Signature _____________________________________","bbox":{"left":0.147059,"top":0.666209,"width":0.35333699999999996,"height":0.017762999999999973}},{"text":"Date ________________________________","bbox":{"left":0.526281,"top":0.666209,"width":0.27527900000000005,"height":0.017762999999999973}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}