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Community Outreach

Programs

Community Service Days Registration Form

You will receive a response within 2 days to confirm registration. Some sites fill up quickly, so please be sure to choose an alternate site.

First Name
Last Name
Local Mailing Address
Phone
Email
Peoplesoft ID
Do you need to complete this project as mandated service either for the courts or ResLife?
Yes No
Do you need to complete this service for course credit?
Yes No

First Choice Work Site

Dec 05, 2009
Foodshare
7:45 AM - 12:45 PM

Second Choice Work Site

Dec 05, 2009
Foodshare
7:45 AM - 12:45 PM

Participant Agreement

Community Outreach, Community Service Days - Participant Agreement

  • I accept my role as a representative of the University and agree to hold myself to high standards of professional conduct/service. I understand that my actions are still governed by the University of Connecticut’s Student Code of Conduct.
  • I agree to fulfill my commitment of hours at my designated Community Service Days site. I will attempt to participate in all activities for which I am physically and emotionally able. If I am unable to be present for my scheduled time, I agree to find a replacement, immediately notify my Team Leader of this change, and provide him or her with the contact information of the student replacing me as a volunteer.
  • I understand it is my responsibility to communicate regularly with my Team Leader prior to the date of my Community Service Days site, as well as during the actual service project, in order to learn about the agency/clients that I’ll be serving, learn about other participants, explore the social issues I’ll be confronting, and acquire any necessary skills training to prevent harm to myself, other participants, or agency clients.
  • I agree to participate in a reflection session that is scheduled upon return to campus from my Community Service Days site.
  • I understand it is my responsibility to communicate regularly with my Team Leader and Community Outreach staff concerning problems that arise or ideas concerning the improvement of the program.
  • I will not use or condone the use of alcohol and/or drugs during the experience.
  • I will respect the cultural, social, economic, spiritual, and other backgrounds of the program’s participants, clients, and communities.
  • I will keep any personal or sensitive information related to my clients, the agency hosting the Community Service Days site, and the program confidential.
  I have read and understand the Participant Agreement

Release and Waiver of Liability Form

Community Outreach, Community Service Days - Release and Waiver of Liability Form
This is a legally-binding Release made by me, and/or my legal guardian, to the University of Connecticut, regarding my participation in the University of Connecticut sponsored Community Service Days program.
As a participant of this program I fully recognize that there may be direct, indirect or inherent risks and hazards involved in the activity of volunteering and it is with full knowledge of the facts and circumstances surrounding this activity and to the extent permitted by the laws of the State of Connecticut, that I release the University of Connecticut, its employees, agents and representatives from any liability whatsoever arising out my participation in this activity. I also understand that the University of Connecticut does not require me to participate in this activity, but I want to do so, despite the possible dangers and risks and despite this Release.
I assure the University of Connecticut that there are no health-related reasons or problems which preclude or restrict my participation in this activity and that I have adequate health insurance necessary to provide for and pay for any medical costs that may directly or indirectly result from my participation in this activity
In consideration of and return for the services, facilities, and any other assistance provided me by the University of Connecticut in this activity, it is my express intent to indemnify and hold the University of Connecticut and its representatives harmless, herein releasing the University of Connecticut and its representatives from any and all liability, claims and/or actions that may arise from injury or harm to me, either from my death or from damage to my property in connection with this activity. I also agree to assume all of the risks and responsibilities in any way associated with this activity and understand that this Release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, as well as my estate, family, heirs, administrators, personal representatives or assigns, if I am deceased and shall be deemed as a “Release, Waiver, Discharge and Covenant” not to sue the above-named University of Connecticut. I further agree to save and hold harmless, indemnify and defend the University of Connecticut from any claim by me or my family, arising out my participation in the activity referenced herein.
If any term of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, the validity of the remaining portions shall not be affected thereby.

I further state that I am at least eighteen (18) years of age, that I have read and agree to the Release and Waiver of Liability. I also state that I am fully competent to sign this Agreement and that I execute this release for full, adequate, and complete consideration, fully intending to be bound by the same.

I am under the age of eighteen (18) and need a Parent/Guardian to sign this Agreement. (Download the Agreement here.