The Ware Institute for Civic Engagement
P.O. Box 3003
Lancaster,
PA 17604-3003
Please Print
Participant Name: __________________________________________________________
Address: __________________________________________________________
Daytime Phone: ___________________________________________________________
Event/Internship
Name: Galveston Relief Trip
Activity or Event: Hurricane
Ike relief work
The undersigned understands
that participation in the above-mentioned event/internship is voluntary and
assumes the risk for any injury of any kind, which might result from that
participation. The undersigned
knows it is their responsibility to assess personal physical abilities and
fitness level before participating in activities for this event. The undersigned confirms that they do
not have any health conditions that would limit ability to safely participate
in the event activities.
The undersigned agrees to:
a) adhere
to all safe work procedures as determined at the work site or as dictated by
task;
b) wear
appropriate personal protective equipment as provided at the work site or as
dictated by task; and
c) follow
the rules set forth by The Ware Institute for Civic Engagement for this
trip.
d) gives
permission for photos taken of me in association with above event to be used by
Franklin & Marshall College
The undersigned agrees to
hold Franklin & Marshall College, Trustees, Officers, Employees, Agents,
Students and all Volunteers harmless for any injuries sustained regardless of
the cause of such injury.
_______________________________________________ _____________________
Signature of Participant Date
Please return completed form to:
The Ware
Institute for Civic Engagement, Franklin & Marshall College
Voice: 717-291-4164 Fax:
717-358-4486