Suburban-Essex Redistribution Project (SERP)

VOLUNTEER RELEASE FORM

I am participating in the Suburban-Essex Redistribution Project (SERP), a program organized by Congregation Bnai Israel, St. Stephen’s Episcopal Church and the Redistribution Center in Denver. In conjunction with my participation in SERP, I hereby release all organizing and affiliated bodies and their directors, employees, clergy, trustees, members, agents, heirs, legal representatives, successors, and assigns, and each of them from any and all claims, present and future, known or unknown, arising out of personal or bodily injuries, death or property damage that may result from or in any way be connected with my participation in SERP, whether cause by the negligence of the organizers, or otherwise. I understand and intend that this release is to be as broad and inclusive as is permitted by law, and that if any portion of this release is held invalid, the balance shall continue in full legal force and effect.

Each participant must sign and submit a release form. Thank you.

Date: _________________________, 2001.

_______________________________ ____________________________

Print name Signature

_______________________________ ____________________________

Print name of parent/guardian if under Signature of parent/guardian if under

18 years of age 18 years of age

I/we are available at the following times:

Wednesday Thursday:

8:00 am – noon ______ 8:00 am – noon_______

noon – 4:30 _______ noon – 4:30 pm _______

or any combination thereof (specify times) ________________________

Name ____________________________ Phone number ____________