Earth Day of Service Registration 2017
Date: Saturday April 22nd
Location: SMSU 238
Registration/light breakfast: 8:30am-9:00am

This year we will be celebrating the 12th anniversary of the Earth Day of Service at Portland State University. This is a day to give back to the Earth by volunteering!

You will work on gardening and community beautification projects on and off the PSU campus and more! Service sites will be on campus (PSU's Student Sustainability Center, Food pantry, and a SOLVE campus clean-up...) and off- campus (SOLVE South Waterfront Clean-up)

The day of service will run from 9 am until 2 pm and will include service with the community, lunch, and a presentation by a keynote speaker.

We seek to provide a fun and engaging day of service that hopefully gets people thinking about their relationships with themselves, their fellow humans, and the ecological community at large.

Email address
First Name
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Last Name
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Gender Pronouns: (They/Them, She/Her, He/Him, etc)
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Portland State Email Address (should end in
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Phone Number:
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Please Check One:
I have read and agree to the following conditions: *
Statement and Assumption of Risk: Participation in the Activity can be hazardous to my health. I understand that I have an increased chance of suffering personal injury, including but not limited to bodily harm, permanent disability, dismemberment, and/or death by participating in the Activity. Injuries that I might incur include, but are not limited to the following: flesh wounds, muscular-skeletal injuries, cosmetic injuries, permanent disabilities and other injuries including death and or dismemberment. I understand that traveling to and from the Activity site may present additional risk of serious injury or death, and agree to comply with Activity requirements for the use of seat belts by vehicle passengers during travel. I voluntarily undertake the Activity and agree to accept all risk associated with my participation in this Activity. Release of Liability and Indemnification Statement I understand that there are unavoidable risks involved with participation in this Activity, and I, individually, and on behalf of my heirs, successors, assigns, and personal representatives, hereby agree to indemnify and hold harmless and release and forever discharge the State of Oregon, the Oregon Board of Higher Education, the Oregon University System, PSU, and their officers, employees, agents, and representatives, from any and all liability and all claims and causes of action whatsoever for any damages to or loss of property, personal illness, or injury (including death) caused by, deriving from, or associated with my participation in the Activity.
I have read and agree to the following conditions: *
Medical Treatment Consent. I fully understand that the Activity may occur in a remote area and that medical services may not be available. In the event of illness or injury to me, and in the event that medical services can be obtained, and if I am unable to grant permission at the time emergency treatment is required, I hereby authorize PSU by and through its authorized representative(s) or agent(s), if any, to secure any necessary treatment including the administration of an anesthetic and surgery. I agree to be the party responsible for all medical expenses that are incurred on my behalf. Statement of Health I certify that I have neither a condition nor circumstance, such as medication, that would prevent me from participating in this Activity. If I have a question concerning my specific situation, may ask an organizer to clarify the Activity, but ultimately the decision to participate is mine. Statement of Insurance I am aware that the State of Oregon does not provide medical insurance coverage for participation in the Activity and therefore take full responsibility for procuring my personal insurance. If I do not have insurance, I accept full, sole and exclusive financial responsibility for the cost associated with any injury or illness.
I have read and agree to the following conditions: *
Choice of Law; Venue Selection. In event of a law suit, I agree that all causes of action will be filed in Multnomah County, Portland, OR and that this Agreement shall be construed in accordance with the laws of the State of Oregon. Severability If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby. Final Acknowledgment The forgoing is submitted in consideration of PSU and the department and./or program noted above allowing my participation in this Activity. I confirm that I am over 18 and I execute this document with full knowledge of the contents and consequences stated in this release.
Photograph/Video Consent & Release *
I authorize Portland State University (University) to: (a) Record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium. (b) Use my name in connection with these recordings. (c) Use, reproduce, exhibit or distribute to any person and in any medium (including print publications, video tapes, CD-ROM, University webpage, and other internet postings such as YouTube, Flickr, etc.) these recordings for any purpose that the University deems appropriate, including promotional or advertising efforts. I release the State of Oregon and the University and those acting pursuant to its authority from liability for any violation of any personal or proprietory right I may have in connection with such use. I understand that all such recordings, in whatever medium, shall remain the property of the University. This release will remain in effect unless and until revoked by me in writing and delivered to the University. I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THIS RELEASE
Emergency Contact: Please provide full name and phone number
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Do you need any accommodations?(Including disabilities, activity/mobility restrictions, dietary restrictions, etc.)
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Questions/Comments: *This question is optional.
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