First Name *

Last Name *

Email *
Please enter a GVSU email address ending in @gvsu.edu or @mail.gvsu.edu.

Phone Number *

Do you have any dietary restrictions *
- Select Option Yes No

Please list any dietary restrictions that you would like us to know about. *

Are you registering with a student group or class? *
- Select Option Yes No

Please list the student group/class you will be registering with. *

Site Leaders are an important part of MLK Day of Service as they lead participants through volunteer activities and reflection activities. They also serve as an important point of contact for our site supervisors and our office in the case of any issues or emergencies. It is a great opportunity to gain valuable leadership experience.

Would you be interested in becoming a site leader? *
- Select Option Yes No

Thank you for your interest in becoming a site leader! We will be in touch with more information soon.

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Are you under 18? *
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 Valley 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 alternative 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.