Name of Person Giving Release: _______________________________________

Party Released: Swarthmore College, its agents and employees including Board of Managers, directors and officers, administration, faculty and staff.

Release: I release and give up all claims I now have or may have in the future against the Party Released arising from my participation in the following Swarthmore Foundation or John W. Nason Community Service Fellowship volunteer project:

I also understand that the volunteer activity set forth above is undertaken by me on a completely volunteer basis. I make this decision by choice and my participation in this activity is undertaken knowing that certain risks may be involved. These risks include, but are not limited to, property loss or damage, and physical injury, temporary or permanent, and death. I recognize that the locations in which I am working can be dangerous, in day or in night, and I voluntarily assume the risk of these dangers by choosing to participate in the activity. I understand that Swarthmore College does not assume any risk or liability due to my participation in this volunteer activity. I understand this release applies to all claims for property loss, injury or illness, or death or any other damages suffered by me, whether suffered in transport to the activity or during the activity itself.

Binding: This release binds me, my heirs and personal representatives. I understand that it benefits the heirs, personal representatives or successors and assigns of the Party Released.

Signed: Before signing my name to this Release, I state that:

1. I have read it.

2. I understand it and know that I am giving up important rights.

3. I sign it freely as my own act and deed, and

4. I intend to be legally bound by it.

_____________________________________________________________ Student Signature, Date Class

Addendum: I certify that I am covered by an independent health insurance policy.

1998 Policy #:____________________________________ Carrier:______________

If 17 years of age or younger include Signature of Parent, Legal Guardian, or Foster Parent on line below.

__________________________________________________________________