AGREEMENT FOR TRANSPORT OF MINOR- VOLUNTARY
This Agreement is made this _____ day of ______________, 20___, by
and between I-15 Express, 2164 West 546 South,
RECITALS
WHEREAS, I-15 Express is in the business of transporting minor children
between the ages of twelve and eighteen around the United States to wilderness
programs, boarding schools and residential treatment centers;
WHEREAS, Guardian desires to retain the services of I-15 Express under
the terms and conditions set forth herein for the purpose of transporting his
or her minor child to the facility/program identified herein;
WHEREAS, I-15 Express desires to be retained under the terms and
conditions set forth herein for the purpose of transporting Guardian’s minor
child to the facility/program identified herein; and
WHEREAS, the parties desire to reduce their agreement to writing
herein,
1. Recitals. The parties intend that the statements and
information set forth in the Recitals be part of this Agreement and the same
are incorporated herein by this section and reference.
2. Statement of Guardian’s
Authority. Guardian hereby represents, asserts and
attests that he/she/they are the parents and/or legal guardians of
___________________ aka _________________ (“Minor”)
and that he/she/they has/have legal authority to enter into this Agreement and
to have Minor transported by I-15 Express as set forth herein. If Guardian is the parent of Minor but is
divorced from Minor’s other natural parent, Guardian hereby represents, assets
and attests that he/she has legal custody of Minor and has the legal authority
to have Minor transported by I-15 Express as set forth herein.
3. Transportation. Guardian grants to I-15 Express permission
and authority to pickup Minor and to transport him/her by whatever means are
reasonably necessary from the pickup address listed hereafter and to deliver
him/her to the owner, manager and/or representative of the destination
treatment center listed hereafter:
1.
PICKUP ADDRESS:
_________________________
_________________________
City:__________________State:_____Zip Code: ______________
Contact Phone number:
__________________________
E-Mail Address:_________________________
2.
DESTINATION ADDRESS:
Name of Facility: _________________________
Authorized Drop-Off Person: ________________________
City:__________________State:_____Zip Code: ______________
4. Cost of Services. Guardian agrees to pay to I-15 Express the
amount of $____________. Guardian agrees
to pay I-15 Express a non-refundable deposit in an amount equal to the costs of
transportation before I-15 Express will leave to pick up Minor. Guardian
further agrees to pay I-15 Express the balance of fees due before agents leave
to pick up Minor, unless special arrangements have been agreed upon by both
parties. Once travel has commenced, all
fees are non-refundable. The following additional information regarding payment
shall be part of this Agreement if the same is initialed by all parties hereto:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
I-15 Express: __________;
Guardian(s): __________ and __________.
5. Authority. Guardian’s grant to I-15 Express, its owners,
officers, managers, employees, agents and assigns, all legal rights to Minor
for the purposes set forth herein. I-15
Express, its owners, officers, managers, employees, agents and assigns shall be
considered to be the legal guardian of Minor for all purposes set forth herein
and shall be able to represent said authority to any airline representative,
law enforcement representative or other individual or entity that may inquire
regarding the authority of I-15 Express.
6. Power of Attorney. Guardian shall grant to I-15 Express, its
owners, officers, managers, employees, agents and assigns, a limited and
specific power of attorney to act in their stead for and on behalf of Minor. Said limited and specific power of attorney
is attached hereto and is made part hereof by this reference. Guardian agrees to execute said limited and
specific power of attorney prior to I-15 Express’s pickup of Minor. This limited and specific power of attorney
shall grant to I-15 Express, its owners, officers, managers, employees, agents
and assigns, the authority and power to do the following for and in behalf of
Minor in the absence of Guardian:
1.
Health Care. I-15 Express shall have
authority to procure and provide to Minor any health care (including dental
care) that shall become reasonably necessary during the transportation
process. Guardian shall be solely liable
for any costs associated with said health care and, should I-15 Express incur
any expenses associated therewith, Guardian shall immediately reimburse I-15
Express for said expenses.
2.
Medicines and Prescriptions. I-15
Express shall have authority to procure and provide to Minor any medicines and
prescriptions, including over the counter medications, that shall become reasonably
necessary during the transportation process.
Guardian shall be solely liable for any costs associated with said
medicine or prescriptions and, should I-15 Express incur any expenses
associated therewith, Guardian shall immediately reimburse I-15 Express for
said expenses. All medications must be approved in advance by the
program Minor is being transported to.
3.
Emergency Care. I-15 Express
shall have the authority to procure and provide to Minor any emergency care
that shall become reasonably necessary during the transportation process. Guardian shall be solely liable for any costs
associated with said emergency care and, should I-15 Express incur any expenses
associated therewith, Guardian shall immediately reimburse I-15 Express for
said expenses.
4.
Any Other Authority Necessary for Transportation. I-15 Express shall have any other authority
necessary to complete the transportation of Minor as set forth in this
Agreement.
The
limited and specific power of attorney granted by Guardian to I-15 Express, its
owners, officers, managers, employees, agents and assigns, shall expire and
have no further legal force or effect upon the delivery of Minor to the
location and person(s) identified in paragraph
7. Restraints. In the event that the escort becomes involuntary,
after I-15 Express has been previously informed that the person is coming
voluntarily, I-15 Express Agents are under no obligation to detain or restrain
the person being escorted, and all fees are non-refundable. Guardian
understands that a “voluntary” escort will consist of a minimum of one Agent of
the same gender as the person being transported. If Guardian desires more than
one Agent, this will constitute an “involuntary” escort.
8. Medical Conditions. Guardian represents that Minor has the
following health concerns and/or issues:
Current Medical Condition(s) for which Minor is receiving treatment or for which treatment was provided in the last 5 (five) years:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_______________________________________________________________
Primary Physician or Treating Physician for above treatments:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Drugs and Medications Minor is presently taking (include dosages):
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Allergies of Minor to food, medicine, etc.:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
The parties agree that the information contained in this Section is
intended for informational purposes only.
No information contained
in this Section shall create any additional duty or liability upon I-15
Express. Guardian shall bear all risk
associated with any of the
identified medical condition, medication or allergy and shall indemnify I-15
Express from any injury or harm that may occur to Minor as a result of
said conditions, medications or allergies.
For purposes of this Agreement, the information contained in this Section shall be
considered inclusive. Guardian shall
bear all risk associated with any omission of information in this Section and shall
indemnify and hold I-15 Express harmless from any injury or harm that should
come to Minor as a result of any omission of information in this Section.
9. Current Injuries or Physical Marks, Bruises,
Etc.
At the time of pickup, upon physical examination, Minor has the
following injuries or physical marks, bruises, etc.:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
10. Assumption of Risk, Release
and Waiver of Liability and Indemnification.
1.
Assumption of Risk–Damages Caused by Minor. Guardian agrees to assume all risk with
respect to the transport of Minor as set forth herein. Guardian shall be solely responsible and
liable for any damages, claims, law suits, actions, or other matter resulting
out of any damage caused by or that may be caused by Minor to the property or
persons of I-15 Express, its owners, officers, managers, employees, agents and
assigns, and to the property or persons of any third-parties during the
transportation process as set forth herein.
Guardian agrees to indemnity and hold I-15 Express, its owners,
officers, managers, employees, agents and assigns, harmless for any damages
caused by Minor during the transportation process whether or not I-15 Express
contributed to the loss caused by the Minor.
2.
Waiver of Liability. Guardian agrees to waive on
behalf of himself/herself, and any heirs and assigns, any and all liability on
the part of I-15 Express, its owners, officers, managers, employees, agents and
assigns, that arises or that may arise resulting from the transportation
process set forth herein. This liability
waiver shall apply to any claims or actions that may or could be brought
against I-15 Express, its owners, officers, managers, employees, agents and
assigns, for any and all property damage or personal injury that may result to
Minor during the transportation process as set forth herein. This waiver shall apply whether or not
restraints must be used and whether or not I-15 Express, its owners, officers,
managers, employees, agents and assigns are negligent in causing any damage or
injury to Minor.
3.
Waiver of Liability . Guardian
agrees and represents that I-15 Express has made no representations regarding
the applicable program to which Minor is to be transported. Guardian expressly represents that he/she has
made the decision to send Minor to a particular program by himself/herself with
no input or advice from I-15 Express.
Guardian agrees that should there be any accident, injury or liability
that occurs to Minor while in the residential treatment center or other
program, Guardian will bring no lawsuit or other action against I-15 Express
and will specifically hold I-15 Express harmless from any liability or damages
that may result from Guardian’s choice of residential treatment center or other
program. Guardian agrees that he/she has
checked with the program to verify that weight and medication requirements of
Minor comply with the rules of the program.
4.
Indemnification. Guardian
agrees to indemnify and hold I-15 Express, its owners, officers, managers,
employees, agents and assigns harmless from any action that may or could be
brought by Minor against I-15 Express, its owners, officers, managers,
employees, agents and assigns at any time after Minor reaches the age of
majority. Should Minor bring an action
against I-15 Express, its owners, officers, managers, employees, agents and
assigns after Minor reaches the age of majority, Guardian agrees to provide for
and pay for all costs associated with defending I-15 Express, its owners,
officers, managers, employees, agents and assigns, and any judgment that may be
rendered against I-15 Express, its owners, officers, managers, employees,
agents and assigns, as a result of said action.
11. Termination of I-15
Express’s Duties and Obligations. The duties
and obligations of I-15 Express, its owners, officers, managers, employees, agents
and assigns hereunder shall terminate at the time that I-15 Express, its
owners, officers, managers, employees, agents and assigns deliver Minor to the
program and authorized drop-off person as set forth in paragraph 2, herein. I-15 Express, its owners, officers, managers,
employees, agents and assigns shall require the authorized program and drop-off
person to sign for and acknowledge receipt and delivery of Minor indicating the
date and time of delivery. Said signed
acknowledgment shall terminate the obligations of I-15 Express, its owners,
officers, managers, employees, agents and assigns on the date and at the time
indicated. Sections 8 and 10, herein and
any other provisions of this Agreement waiving liability or indemnify I-15
Express, its owners, officers, managers, employees, agents and assigns shall
survive any termination of the duties and obligations of I-15 Express, its
owners, officers, managers, employees, agents and assigns, and the termination,
if any, of this Agreement or any part thereof.
12. Miscellaneous.
12.1 Savings Clause. If any provision of this Agreement, or the
application of such provision to any person or circumstance, shall be held
invalid, the remainder of this Agreement, or the application of such provision to
persons or circumstances other than those as to which it is held invalid, shall
not be affected thereby.
12.2 Binding Effect. This Agreement shall be binding upon and
inure to the benefit of the parties hereto and their respective legal representatives,
successors and permitted assigns.
12.3 Entire Agreement;
Modifications. This Agreement
contains the entire agreement between the parties relating to the transactions
contemplated hereby and all prior or contemporaneous agreements, understands,
representations or statements, oral or written, are superseded hereby. No waiver, modification, amendment, discharge
or change of this Agreement shall be valid unless the same is in writing and
signed by both parties to this Agreement.
12.4 Attorney Fees and
Law Governing. Should any party seek the assistance of the Courts to
enforce this Agreement or any part thereof or to otherwise adjudicate their
rights or responsibilities hereunder, the losing party shall be required to pay
to the prevailing party all its costs and attorney fees associated with such an
action. This Agreement shall be
governed by and construed in accordance with the laws of the State of
12.5 Waiver. Failure of either party at any time to
require performance of any provision of this Agreement shall not limit the
party's right to enforce the provision, nor shall any waiver of any breach of
any provision be a waiver of any succeeding breach of any provision or a waiver
of the provision itself for any other provision.
12.6 Assignment. Except as otherwise provided within this Agreement,
neither party hereto may transfer or assign this Agreement.
12.7 Presumption. This Agreement or any section thereof shall
not be construed against any party due to the fact that said Agreement or any
section thereof was drafted by said party.
12.8 Computation of Time. In computing any period of time pursuant to
this Agreement, the day of the act, event or default from which the designated
period of time begins to run shall be included, unless it is a Saturday, Sunday
or a legal holiday, in which event the period shall begin to run on the next
day which is not a Saturday, Sunday or a legal holiday, in which event the
period shall run until the end of the next day thereafter which is not a
Saturday, Sunday or legal holiday.
12.9 Titles and Captions. All article, section and paragraph titles or
captions contained in this Agreement are for convenience only and shall not be
deemed part of the context nor affect the interpretation of this Agreement.
12.10 Pronouns and Plurals. All pronouns and any variations thereof shall
be deemed to refer to the masculine, feminine, neuter, singular or plural as
the identity of the Person or Persons may require.
12.11 Further Action. The parties hereto shall execute and deliver
all documents, provide all information and take or forbear from all such action
as may be necessary or appropriate to achieve the purposes of this Agreement.
12.12 Good Faith,
Cooperation and Due Diligence. The
parties hereto covenant, warrant and represent to each other good faith,
complete cooperation, due diligence and honesty in fact in the performance of
all obligations of the parties pursuant to this Agreement. All promises and covenants are mutual and
dependent.
12.13 Counterparts. This Agreement may be executed in several
counterparts and all so executed shall constitute one Agreement, binding on all
the parties hereto even though all the parties are not signatories to the
original or the same counterpart.
Facsimile copies and signatures shall be considered to be originals for
all purposes set forth herein.
12.14 Notices. Any notices necessary pursuant to this
Agreement shall be mailed to the addresses set forth above. If the notice is sent certified, return receipt
requested, notice shall be deemed received on the date of mailing. If the notice is sent regular, first class
mail, notice shall be deemed received when actually received by the recipient.
12.15 In the event that Guardian cancels the
transport after travel has already commenced, or in the event that Minor is not
present when I-15 Express arrives at the pickup location, all fees are
non-refundable. In addition, if Guardian fails to disclose any medical
conditions, medications or other factors that make it impossible for I-15
Express to carry out the transport, Guardian agrees to compensate I-15 Express
as stated above. In the event that Guardian prevents I-15 Express agents from
carrying out the transport in a manner recommended by I-15 Express agents
designed to safely and successfully accomplish the transport, Guardian agrees
that all fees are non refundable.
12.16 In the event that Minor,
due to extreme behavior, threats or other behavior that causes he/she to be
unable to board a commercial airliner, causes I-15 Express agents to have to
transport him/her by ground transport instead, Guardian agrees to compensate
I-15 Express at a rate of $500 per 24 hour period or fraction thereof, to cover
additional costs of car rental, gas, food and hotel if necessary. Guardian also understands that if ground
transport becomes necessary, I-15 Express is not responsible for refunding any
airfare that has been already purchased.
12.17 In the event that
weather causes a delay which prevents I-15 Express from completing the
transport as scheduled, Guardian agrees to compensate I-15 Express for
additional hotel, rental car and miscellaneous expenses amounting to no more
than $350 per 24 hour period or fraction thereof, in addition to any change
fees imposed by the airline.
IN
WITNESS WHEREOF, the parties hereto have executed this agreement as of the day
and year first herein above written.
GUARDIAN(S):
______________________________
_______________________________
Print Name: ____________________
Print Name: _____________________
STATE OF ______________)
: ss.
COUNTY OF ____________)
On
the _____ day of _______________. 20___, personally appeared
before me _____________________ and ____________________ who
duly acknowledged to me that they executed the foregoing documents and the
statements made therein are true and accurate to the best of his/her/their
knowledge.
_____________________________________Notary
Public
_____________________________________Date
I-15 EXPRESS, INC.
________________________________
By:
_____________________________
Its:
_____________________________
***************************************************************************************************
The above listed youth
(_______________________________) was delivered to representatives of ___________________________________ on this
_________ day of ___________, 20__, at ___________AM/PM.
_______________________________________
Representative of Program
_______________________________________
I-15 Express Representative