Alternative Spring Breaks Waiver Form 2013
Boston University Community Service Center
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Alternative Spring Breaks 2013 Volunteer Contract
As a volunteer for the Boston University Community Service Center’s Alternative Spring Breaks 2013 Program, I agree to each of the following conditions:
- I will meet my volunteer group at the specific time and place appointed by the Coordinators.
- Due to limited space in the vans, I will bring only what I need for the week out of respect to the other volunteers.
- I agree not to consume any alcohol or drugs from Saturday, March 9th to Sunday, March 17th, even if I am over 21 years of age. If I do so I will be asked to leave immediately at my own expense.
- If I have to leave the trip early for any reason, I will assume any added costs.
- I understand that participation fee ($200 for Boston, $350 for public transportation trips, $400 for van trips, and $900 for flying trips) is due in full at the time I register on Saturday, December 1st.
- I understand that if I choose to apply for a scholarship a $150 non-refundable deposit is due at the time I register and my remaining balance will be due on Thursday, January 17th by 5 pm.
- I will follow all the rules and the policies of Boston University as set forth in the Code of Student Responsibilities, and understand that failure to do so may result in the appropriate disciplinary action.
Also, if I decide to drive, I agree to each of the following conditions:
- I have completed the Van Training process as set forth by the Community Service Center.
- I know nothing that would interfere with my driving a large passenger van for a four hour shift
- I will stop driving if I feel at all tired, and under no circumstances will I drive more than four hours at a time.
- I will make sure that the person riding in the front passenger seat stays awake for my entire shift, and if that person feels tired, I will ask him/her to switch with someone who is willing to stay awake.
- I will not exceed the speed limit at any time, and I assume all financial and legal responsibility for any speeding tickets, parking tickets, or other violations I receive while driving.
ACKNOWLEDGMENT AND WAIVER OF LIABILITY
Boston University Identification Number: U _ _ – _ _ – _ _ _ _
Person to call in emergency:
Home Phone:_____________________ Work Phone:____________________
I would like to participate in the Alternative Spring Breaks (ASB) Program, which is an optional, elective, extra-curricular activity offered by the Boston University Community Service Center.
I acknowledge that I am aware that there are risks to me of injury or property damage entailed in my participation in this extra-curricular activity, including the risks of travel to and from these activities. I do fully and completely assume any risks solely to myself, and accept full responsibility for my individual physical fitness to participate in these activities. Although Boston University will provide as much information as possible on each activity, I also acknowledge that it is my responsibility to request further information about a specific extra-curricular activity if I require such information in order to make a proper participation decision. I understand that the University gives no assurances or guarantees whatsoever as to the safety of participants in these programs.
I understand that this release and indemnification applies to all elective activities offered through the Boston University Community Service Center in which I choose to participate. I also understand that I am not required to participate in any elective activity. My participation in any elective activity is a voluntary decision on my part.
In consideration of being presented opportunities to participate in extra-curricular activities and in acknowledging that I am aware of and willing to assume the risks associated with these activities, I hereby voluntarily agree to waive, hold harmless and indemnify the Trustees of Boston University and its trustees, agents, volunteers and employees from any and all claims, demands, damages and causes of action of any nature whatsoever arising out of ordinary negligence which I, my heirs, my assigns or successors may have against them for, on account of, or by reason of my voluntary involvement with elective activities offered by the Boston University Community Service Center. I understand the content of this document, and I execute this GENERAL RELEASE, WAIVER OF CLAIM AND ASSUMPTION OF RISK AGREEMENT of my own free will and accord during my tenure at Boston University.
PARENT OR GUARDIAN SIGNATURE:_________________________________________
(If under 18 years of age)