Haiti Air Ambulance Service, Inc. (the “Organization”) is a not-for-profit emergency helicopter ambulance transport provider. Membership demonstrates your (the “Member”) commitment to the mission of the Organization to provide emergency helicopter ambulance services in Haiti on the terms and conditions set forth below.
1. Patient transport will be limited to the most appropriate medical facility for medical conditions that are deemed to threaten loss of life or limb, or medical conditions that could lead to permanent disability, and which require emergency helicopter ambulance transport, each as determined by the Organization in its sole and absolute discretion. A patient’s medical condition, not membership status, will dictate whether or not emergency helicopter ambulance transport by the Organization is provided. Notwithstanding the foregoing, and under all circumstances, the Organization retains the sole and absolute discretion to determine: whether or not a patient receives emergency helicopter ambulance transport; and if emergency helicopter ambulance transport is provided, the medical facility to which the patient is transported.
2. Flights beyond the borders of Haiti will be considered on a case-by-case basis, and are limited to the Dominican Republic. No other flights outside of Haiti will be considered. The Organization’s emergency helicopter ambulance flights are limited to operating exclusively during daylight.
3. The Member acknowledges, understands and agrees that the Organization’s emergency helicopter ambulance transport services may not be available when requested due to various factors, including use of the relevant aircraft by another patient; other circumstances governed by operational requirements, restrictions or decisions, including equipment limitations, governmental regulations, maintenance requirements, weather conditions, acts of nature, flight safety, resource and personnel availability or allocation; or the Organization’s discretion.
4. The Organization reserves the right to bill directly any and all appropriate insurance providers, benefits providers and/or third parties (all of the foregoing, collectively, “Responsible Parties”) for services rendered, and the Member hereby expressly authorizes each and all Responsible Parties to pay any covered amounts or amounts which such Responsible Party is responsible for directly to the Organization, such payments in the aggregate not to exceed the Organization’s customary charges for such services. The Member also acknowledges, understands and agrees that: the Organization is NOT an insurance company; membership is not an insurance policy and membership cannot be considered as a supplement to any insurance coverage. The Organization will NOT be responsible for payment for services provided by any other persons or entities, including any ambulance services or health care providers.
5. Membership is effective on the first day of the calendar month following delivery to the Organization by the Member of a completed application with full payment (such day, the “Effective Date”), unless such application is denied by the Organization. In the event of an unforeseen event with respect to which the Organization provides emergency helicopter ambulance transport to the Member after delivery by the Member of a completed application with full payment but before the Effective Date, the Organization shall have the discretion to adjust the effective date of such Member’s membership to any date on or after the date upon which the completed application with full payment was received by the Organization. Memberships are non transferrable, and membership fees are non-refundable.
6. In the event of emergency helicopter ambulance response or transport by the Organization, the Member hereby expressly authorizes and voluntarily consents to such response, transport (including placement of the patient at such receiving facility as the Organization shall determine in its sole and absolute discretion), care, intervention and medical treatment as the Organization or its employees, contractors, designees or agents provide, obtain or deem advisable under the circumstances. The Member acknowledges, understands and agrees that: no guarantees or assurance have been or can be made to the Member as to the availability, effect or success of any such response, transport, care, intervention and medical treatment, or as to any outcomes; and that the Member is not relying and shall not rely on the availability, effect or success of any such response, transport, care, intervention and medical treatment. The Member hereby gives permission to the Organization and its employees, contractors, designees and agents to release any information about the Member, the Member’s health and medical
condition, the services provided to the Member under or in connection with this agreement, and payment for such services, as the Organization shall deem to be appropriate or desirable in its sole and absolute discretion.
7. The Member acknowledges, understands and agrees that: notwithstanding the Member’s denomination as a “member” of the Organization, the Member shall not be a member for purposes of the New York Not-for-Profit Corporation Law; the Organization may not be able to perform or provide services, or such performance or provision of services may be delayed, hindered, curtailed or prevented by circumstances or events outside the Organization’s reasonable control.
8. Understanding the risks involved, the Member voluntarily chooses to avail himself/herself of the Organization’s services, and EXPRESSLY ASSUMES THE ASSOCIATED RISKS, WHETHER CAUSED BY THE RISKS INHERENT IN THESE SERVICES, THE UNINTENTIONAL NEGLIGENCE OF ANY OF THE ORGANIZATION OR ITS EMPLOYEES, CONTRACTORS, DESIGNEES OR AGENTS (COLLECTIVELY WITH THE ORGANIZATION, THE “RELEASED PARTIES”), OR ANY OTHER CAUSE. On behalf of the Member and the Member’s heirs, successors in interest, guardians, legal representatives and assigns, THE MEMBER HEREBY RELEASES AND FOREVER DISCHARGES THE RELEASED PARTIES, JOINTLY AND SEVERALLY, FROM ALL CLAIMS, ACTIONS, SUITS, DEMANDS, RIGHTS, CAUSES OF ACTION AND LIABILITIES, IN LAW OR IN EQUITY, WHETHER THE MEMBER’S OWN OR DERIVATIVE CLAIMS (COLLECTIVELY, “CLAIMS”), BASED UPON ANY BODILY INJURY OR DISABILITY, ILLNESS OR DISEASE, DEATH, FINANCIAL LOSS, PROPERTY LOSS, OR OTHER HARM OF WHATEVER NATURE, WHETHER FORESEEN OR UNFORESEEN (COLLECTIVELY, “LOSS OR DAMAGE”), THAT MAY BE SUSTAINED OR SUFFERED BY THE MEMBER OR BY ANY OTHER PERSON AS A DIRECT OR INDIRECT CONSEQUENCE OF THE SERVICES PROVIDED TO THE MEMBER BY OR THROUGH THE ORGANIZATION, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES OR OTHERWISE, provided that nothing in this paragraph shall be deemed to release any Released Party from liability arising from their own willful or intentional injury to the Member. The Member hereby agrees that the Member, and the Member’s heirs, successors in interest, guardians, legal representatives and assigns, will not bring a claim against, sue, demand compensation from or attach the property or assets of the Released Parties or any of them, either in the Member’s or any other name, for any Loss or Damage arising or resulting directly or indirectly from the services provided to the Member by or through the Organization. The Member agrees to indemnify, defend and hold harmless each of the Released Parties from and against any and all Claims, damages, losses, costs and expenses, including compensatory and punitive damages and attorneys’ fees, arising from or in connection with any Loss or Damage which might result, directly or indirectly, from the services provided to the Member by or through the Organization.
9. These terms and conditions may be modified only by a writing signed by the Member and the Organization. These terms and conditions, together with the Member’s Membership Application, constitute the entire agreement between the parties with respect to the subject matter hereof, and there are no understandings, agreements or representations, express or implied, oral or written, not specified herein. THE MEMBER UNDERSTANDS THAT THE TERMS OF THE EXPRESS ASSUMPTION OF RISK, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT CONTAINED IN THIS AGREEMENT MEAN THAT THE MEMBER IS WAIVING CERTAIN IMPORTANT RIGHTS THAT THE MEMBER MIGHT OTHERWISE HAVE. [Note: choice of law and jurisdiction provision to be inserted after consultation with counsel in Haiti.]
10. In the event any clause, section or part of the agreement between the Member and the Organization shall be held or declared to be void, illegal, unenforceable or invalid for any reason, all other clauses, sections or parts of the agreement which can be effected without such void, illegal, unenforceable or invalid clause, section or part shall nevertheless continue in full force and effect. As used herein, the word “including” and its variants means “including, without limitation.”