Project SERVE 2008: Release of Liability

I, the undersigned University of Virginia Student will participate in Project SERVE on Saturday, September 13, 2008. This activity is conducted purely on a voluntary basis. The Office of the Dean of Students, the Project SERVE Planners, and the Rector and Visitors of the University of Virginia do not require my participation in Project SERVE and they do not supervise or control the activities in which I will be participating.

I understand the University, the Office of the Dean of Students, the Project SERVE Planners and any of their employees or other agents will not be responsible for any harm that may occur in connection with this activity. Any student who participates in this event does so at his/her own risk.

I declare that I am over the age of eighteen years and signify my understanding of the information above. I hereby release the Rector and the Visitors of the University, the Office of the Dean of Students, the SERVE Planners, their employees and other agents from any and all claims arising from any participation in this activity.

If I am below the age of eighteen years, my parent/guardian has signed below, indicating his/her consent to this Release of Liability on my behalf.



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Name (Printed)



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Name (Signature) (parent/guardian if under 18)



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Date

Please fax this form to the Office of Orientation & New Student Programs at 434-982-4506 or bring it to Project SERVE on September 13, 2008.