First Name *

Last Name *

Email *

Phone *

Do you have any dietary restrictions? *

Are you wishing to participate with a Student Organization/Group/Class/Friends? *
- Select Option Yes No

List the Student Organization/Group/Class/Individuals you are wishing to be grouped with: *

After the service projects, participants will be transported to the Pew Campus for lunch and the Keynote Speaker. We will have buses for transporting participants back to the Allendale campus. Will you need transportation at the end of the event? *
- Select Option Yes No

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone *

Are you under 18? *
- Select Option Yes No

COMPLETE IF UNDER 18 - An email will be sent to your parent or guardian via the email address you provide below. Your parent or guardian must use this email to approve your submission in order for your form to be approved. * *

Photo Release: I give Grand Valley permission to use photos taken of me while volunteering for promotional purposes in Grand Valleys newsletter, mailings, and/or website. Do you agree with the previous statement? * *
- Select Option Yes No

Behavioral Contract

I understand that as a member of the GVSU community, I will conduct myself in a professional, safe manner during the program and will strive to represent well Grand Valley State University. I understand that this program is a privilege that will be immediately revoked if I violate any of the following standards:

1. I will travel with my group at all times and will not venture out by myself. 
2. I will arrive on time to all designated travel departures, and I understand I may have to seek alternate transportation at my own expense if I am not present at departure time. 
3. I will abide by all Grand Valley State University policies, conduct rules, and laws of the land at the service location. I understand that any violation of the above standards will cause an immediate trip back to GVSU at my expense.

Travel Release Statement Assumption of Risk and Release for Off Campus Activities

RELEASE EXECUTED by the undersigned to Grand Valley State University, One Campus Drive, Allendale, MI 49401 IN CONSIDERATION of being permitted to participate in a voluntary activity that will involve travel off campus grounds offered through Grand Valley State University, I the undersigned, in full recognition and appreciation of the dangers and hazards inherent to participating in this activity/program to which I may be exposed during my enrollment and/or participation in this activity/program, do hereby agree to assume all the risks and responsibilities surrounding my participation in this activity/program or any independent activities undertaken as an adjunct thereto; and further, I do for myself, my heirs, and personal representative(s) hereby defend, hold harmless, indemnify, and release, and forever discharge and all its officers, agents and employees from and against and all claims, demands, and actions, or causes of action, on account of damage to personal property, or personal injury, or death which may result from my participation, and which result from causes beyond the control of, and without the fault or negligence of Grand Valley State University, its officers, agents, or employees, during the period of my participation as aforesaid.

Please sign below if you agree.