Medical Mission

Capacity Building - Strengthening the Healthcare System to Save Lives

The requirements for a local shipment and the international is different.
We advise that you go read the application carefully and complete the section that is applicable to you and your organization.

For additional information, do contact us or sent a direct email to the [email protected].

Medical Mission - Local & International Shipment

Medical Mission Team
Type of Medical Mission & Shipment

Main Contact Person

First
Last
Address
City
State/Province
Zip/Postal
Country

Medical/Healthcare Personnel

Medical Personnel (choose which applies)
Name of Professional
Name of Professional
First
Last

Facility or Health Center

Type of facility
Address of Facility or Health Center
City
State/Province
Zip/Postal
Country

Shipping (complete section for international shipment)

Consignee This is the organization which appears on official shipping documents as the recipient of the container. In some cases the Consignee is the healthcare institution which will utilize the donated medical supplies. In other cases it is a charitable organization which will receive the container and give the donated medical supplies to a local healthcare institution.
Address EXACTLY AS IT SHOULD APPEAR ON OFFICIAL SHIPPING DOCUMENTS (street, city, state/province, postal code, etc. DO NOT PROVIDE P.O. BOX.) *
City
State/Province
Zip/Postal
Country
Legal Status of this Organization
Humanity & Health Foundation and its agency partner will ships the container to the ocean port nearest to the consignee. The consignee is responsible for transporting the container from the port to the hospital(s) where the medical supplies will be used.
HHF requires the consignees to obtain written permission for duty-free import from the appropriate government agency prior to shipment of the container. Do you currently have permission for duty-free import?
Humanity and Health Foundation requires the consignees to obtain written permission for duty-free import from the appropriate government agency prior to shipment of the container. Do you currently have permission for duty-free import? *
What laws does your country have regarding importation of donated medical supplies and equipment? (Check all that apply.)
Who will cover this cost? (For international shipment only)
HUMANITY AND HEALTH FOUNDATION IS A REGISTERED NON-PROFIT ORGANIZATION AND ALL OF THE MEDICAL SUPPLIES AND EQUIPMENT WE SEND ARE DONATED. HOWEVER, WE DO REQUIRE FUNDING TO COVER OUR OPERATIONAL COST AND THE COST OF SHIPPING.

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Recipient Agreement, Disclaimer & Signature

I guarantee that the supplies I receive as donations from Humanity & Health Foundation, INC and its partner agencies, will be delivered to the organization described above to benefit patients in need. I understand that these supplies are donated, have no commercial value, and therefore I will not sell or exchange these items for profit. I further attest that I have read and agree to receive donated items from HHF and its partners according to the stipulations below. By submitting this application, I affirm that the facts set forth in it are true and complete. I agree to help out with no expectation of monetary compensation, and will work in accordance with the Humanity and Health Foundation ethical principles. Recipient organization agrees to provide Humanity and Health Foundation & its Partners with photos and feedback whenever possible related to how the medical supplies and equipment from this shipment are used. Recipient organization gives Humanity and Health Foundation & its Partners permission to use stories, photos and video related to this shipment for marketing and fundraising purposes.
Disclaimer:

The medical supplies, equipment, materials, and other items (“Materials”) available from Humanity and Health Foundation & its Partners (“Humanity and Health Foundation & its Partners”) are items that would have been discarded or otherwise disposed of by hospitals or health care providers in the United States. These Materials are being made available strictly on an “as is” basis for humanitarian use in circumstances in which sufficient alternative sources of such resources are not available. The recipient organization recognizes that Humanity and Health Foundation & its Partners and the donor facilities do not make any representations or warranties, either express or implied, as to the condition of the Materials, and further recognizes that Humanity and Health Foundation & its Partners and the donor facilities make no representations or warranties, express or implied, that the Materials are fit, appropriate, free from defects, sterile, pure, operable, or otherwise suitable for any intended purpose. The recipient organization accepts the Materials “as is,” with all faults, and acknowledges that the inspection for any defects and the safe operation of said Materials is solely the responsibility of the recipient organization. Each recipient organization, recipient facility, and responsible manager of such entities assumes full responsibility for making an independent determination of the appropriateness of the Materials (or any part thereof) before using them, and for discarding any Materials which are not appropriate for use. Under no circumstances shall Humanity and Health Foundation & its Partners, the manufacturer or distributor of the Materials, or any United States hospital or health care provider that ever owned or used the donated equipment, be liable to recipient organization or anyone for any direct, special, indirect, incidental, or consequential loss or damage resulting from the Materials or their use. To the maximum extent permitted by law, the recipient organization fully accepts and assumes all risks and all responsibility for losses, costs, and damages that the recipient organization, its agents, representatives, members, directors, officers, employees, agents, contractors, patients, and transferees (“Users”) may incur as a result of the Materials or their use, including without limitation personal injuries, illness, damage, loss to property, and death.

Humanity and Health Foundation & its Partners and the recipient organization recognize that this agreement shall release Humanity and Health Foundation & its Partners and the donor facilities from any and all liability for personal injury and/or any other type of injury arising from the use of the Materials. The recipient organization acknowledges that the consideration for this release and indemnification is the donation of the Materials themselves. By making an application for the receipt of such Materials and by accepting such Materials, the recipient organization, to the maximum extent permitted by law, fully releases, acquits, and forever discharges Humanity and Health Foundation & its Partners , the donor facilities, and each and every past and present subsidiary, affiliate, officer, director, agent, servant, employee, trustee, and representative of Humanity and Health Foundation & its Partners  and the donor facilities (“Released Persons and Entities”) from any and all loss, damages, claims, causes of action, suits, debts, liens, obligations, liabilities, demands, costs and expenses of any kind, character, or nature whatsoever, known or unknown, fixed or contingent, which might arise from or be related or associated in any way with the Materials or their use, including but not limited to any injury, illness, disease, property damage, death, or loss of any nature suffered or sustained in connection with the use or possession of the Materials. To the maximum extent permitted by law, the recipient organization also agrees to indemnify, save, and hold the Released Persons and Entities harmless for any loss, damages, claims, causes of action, suits, debts, liens, obligations, liabilities, demands, costs and expenses (including attorneys’ fees) of any kind, character, or nature whatsoever, known or unknown, fixed or contingent, which may be incurred arising out of or related to the use or possession of the Materials, regardless of the nature or the extent of the injury, illness, disease, property damage, death, or loss, and regardless of whether it results from the negligence of the Users or of the Released Persons and Entities.