Glendale Community College is a non-profit educational institution. References to Glendale Community College include Glendale Community College, the Maricopa County Community College District (MCCCD), its officers, officials, employees, students, agents, and assigns.

I _______________________________freely choose to participate in the GCC Service Learning Program (henceforth referred to as the Program).

In consideration of my voluntary participation in this program, I agree as follows:

Risk of Program Activities: I understand that my participation in the Service Learning College Program specified above involves risks of physical harm or injury inherent in service activities including, but not limited to, working with people, participating in sports and recreation activities, cleaning and maintenance projects, preparing and serving food, and other service activities, and in transportation to and from service work sites.

Institutional Arrangements: I understand that Glendale Community College is not an agent of, and has no responsibility for, any third party that I may provide any program services to. I understand that Glendale Community College provides guidance and facilitates my Program activities only as a convenience to participants and that accordingly, Glendale Community College accepts no responsibility, in whole or in part, for loss, damage or injury to persons or property whatsoever, caused to me or others while participating in the Program. I further understand that Glendale Community College is not responsible for matters that are beyond its control.

Independent Activity: I understand that Glendale Community College is not responsible for any loss or damage I may suffer when I am doing Program activities and that Glendale Community College cannot and does not guarantee my personal safety. In addition, I specifically acknowledge that in performing Program activities, I am doing so independently in the status of server/volunteer of the service site I choose, and not as a server/volunteer, employee or agent of Glendale Community College. I further waive any and all claims which may arise from such Program activities, acknowledge that workers' compensation benefits are not provided to me in my capacity as a server/volunteer, and hold Glendale Community College blameless from any of my negligent acts. I further state that I am not in any way an employee of Glendale Community College.

I further agree that I am solely responsible for my own equipment, supplies, personal property, and effects during the course of Program activities.

In addition, I agree that if I drive or provide my own motor vehicle for transportation to, during, or from the Program site, I am responsible for my own acts and for the safety and security of my own vehicle. I accept full responsibility for the liability of myself and my passengers, and I understand that if I am a passenger in such a private vehicle, Glendale Community College is not in any way responsible for the safety of such transportation and that Glendale Community College's insurance does not cover any damage or injury suffered in the course of traveling in such a vehicle.

Health and Safety: I have been advised to consult with a medical doctor with regard to my personal medical needs. I state that there are no health-related reasons or problems that preclude or restrict my participation in this Program. I have obtained the required immunizations, if any.

I understand that I may be required to pay up front for my medical expenses that I incur while participating in this Program. Further, I understand that I am responsible for submitting any medical receipts to my insurance carrier upon my return. I recognize that Glendale Community College is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. Glendale Community College may (but is not obligated to) take any action it considers to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses relating thereto and release Glendale Community College and MCCCD from any liability for any actions.

Participating in any activity is an acceptance of some risk or injury. I agree that my safety is primarily dependent upon taking care of myself. I understand that it is my responsibility to know what personal equipment is required (such as footwear, clothing, and other protective equipment) and provide the proper personal equipment for my participation in the Program, and to ensure that it is in good and suitable condition. I agree to ask questions to make sure that I know how to safely participate in the Program activities, and I agree to observe the rules and practices which may be employed to minimize the risk of injury while participating in the Program activities. I agree to reduce the risk of injury to myself or others by limiting my participation to reflect my personal fitness level, wearing the proper protection as dictated by the activity, not wearing anything that would pose a hazard in the performance of the activity, not ingesting or using any substance during the activity which could pose a hazard to myself or others. I agree that if I fail to act in accordance with this agreement that I may not be permitted to continue to participate in the activity.

Assumption of Risk and Release of Liability: Despite precautions, accidents and injuries can and will occur. I understand that participation in some of the Program activities may be potentially dangerous, and that I may be injured or lose or damage personal property as a result of participation in the Program. Therefore, I assume all risks related to the Program activities. Knowing the risks described above, and in voluntary consideration of being permitted to participate in the Program, I agree to release, indemnify, and defend Glendale Community College and MCCCD and their officials, officers, employees, agents, volunteers, sponsors, and students from and against any claim which I, the participant, my parents or legal guardian or any other person may have for any losses, damages or injuries arising out of or in connection with my participation in this Program.

Signature: I indicate by my signature below that I have read the terms and conditions of participation and agree to abide by them. I have carefully read this Release Form and acknowledge that I understand it. No representation, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. The Release Form shall be governed by the laws of the State of Arizona which shall be the venue for any lawsuits filed under incident to this Release Form or to the Program. If any portion of this Release Form is held invalid, the rest of the document shall continue in full force and effect.

Signature of Program Participant____________________________________________________ Date ________________

Signature of Parent or Legal Guardian________________________________________________ Date ________________ (If student is a minor)

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Direct feedback to: Randy Kimmens
URL: http://www.gc.maricopa.edu/servicelearning/frisk.htm
Last update: Tuesday November 14 2000