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Center for Service and Community Engagement

"When the heart is touched by direct experience, the mind may be challenged to change. Personal involvement with the innocent suffering, with the injustice others suffer, is the catalyst for solidarity, which then gives rise to intellectual inquiry."
 
 
- Peter-Hans Kolvenbach, S.J.
 

Labor of Love Registration
 

Please fill out the form below and click "Submit." If you are not directed to a confirmation page, please contact Elizabeth O'Brien. Thanks!

Personal Information

Name
Email Address
Current Address
Phone Number
Student, Alumni, or Staff?
Attending with a group? Y/N
If yes, name of group (Campion 4th Floor, Johnson Family, etc.)
Are you planning to be a site leader?
Will you be 18 years old by April 26, 2008?
Please list any disabilities or special needs.


Emergency Contact Information: Please provide two people who can be reached in case of emergency.

Contact Name and relationship
Contact Address
Contact Daytime Phone


Medical Information

Please list any allergies
Medications
Special Health Needs

Please read and complete the following:

PARENTAL CONSENT/RELEASE - If you are under 18 years of age, you must print this form for your parents to sign. An electronic signature will not be accepted. Please FAX or mail signed release to the Center for Service and Community Engagement.

LIABILITY RELEASE - I hereby release, indemnify and hold harmless Seattle University, its officers, directors and employees, and the organizers, sponsors and supervisors of all 2008 Labor of Love activities from any and all liability in connection with any injury I may sustain (including any injury caused by negligence) in conjunction with the 2008 Labor of Love event on Saturday, April 26, 2008. To the extent not insured, I likewise release and hold harmless from liability any person transporting me to or from the 2008 Labor of Love activities.

Signature (type name) : Date:

COMMUNICATIONS RELEASE - I hereby give to Seattle University, to its nominees, agents and assigns, my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages by reason thereof, to use, publish, republish or exhibit in the furtherance of its work, with or without identification of me by name, the photographs, videos, or statements taken on this day, Saturday, April 26, 2008, and to disseminate statements referring to me in conjunction therewith if Seattle University so desires and to authorize any newspaper, company or other organization to use, publish, republish or exhibit said photograph with or without identification of me by name and to publish or disseminate statements referring to me in conjunction therewith in the promotion of Seattle University and any of its fund campaigns or any of its activities.

Signature (type name) : Date:

CODE OF CONDUCT - I understand that the responsibilities and circumstances of an off-campus service opportunity require a standard of professional decorum. Therefore, I indicate my willingness to understand and conform to the standards, policies, and procedures of the Agency. I further understand that it is important to the success of the program and the continuance of future Labor of Love participants that students observe Seattle University’s Code of Conduct, so as not to compromise Seattle University in the eyes of individuals and organizations with which it has dealings, and I acknowledge the Center for Service and Community Engagement’s responsibility for setting rules and interpreting conduct for this purpose. I agree that the University or the Agency has the right to terminate me from my service because of conduct that might bring the program into disrepute or that violates Seattle University or Agency policies. All final resolutions of my academic status in such situations will be made by the University.

Signature (type name) : Date: