Service-Learning Agreement
Student & Course Information
Student Name
Student Email Student Phone
Course Number and Section Instructor
Semester (circle one) Fall Spring Summer 20
Service Learning Site/Community Partner Information
Organization
Primary Contact Contact Job Title
Contact Email Contact Phone
Project Information
Begin End
Estimated total hours of service
Project Name
Project Description/What kind of service will you provide for this agency?
How will this experience connect with the learning you will do in your course?
Waiver, release, and indemnification agreement
I have voluntarily agreed to participate in a service-learning activity, sponsored by Saint Paul College
—A Community & Technical College (“College”), in which I will provide service at or for a community
organization.
I have learned about the requirements and expectations of this service-learning activity in my
course syllabus, other course documents, or through instructor communication. I am fully aware of
the dangers and risks to my person and property involved in participating in these activities, which
include, but are not limited to, loss of or damage to personal property, bodily injury, or even death.
In consideration of the College’s permitting me to participate in this activity, I hereby agree as
follows:
1. I agree to abide by the safety rules and regulations as set by the course instructor and
community organization. Failure to do so will disqualify me from participation.
2. I, individually, and on behalf of my heirs, successors, assigns and personal representatives,
hereby release and forever discharge the College, the State of Minnesota, and its employees,
agents, ofcers, trustees and representatives (in their ofcial and individual capacities)
(“Releasees”) from any and all liability whatsoever for any and all damages, losses or injuries
(including death) I sustain to my person or property or both, including but not limited to any
claims, demands, actions, causes of action, judgments, damages, expenses and costs, including
attorney fees, which arise out of, result from, occur during, or are connected in any manner with
my participation in the activity whether caused by the negligence of the Releasees or otherwise;
except that which is the result of gross negligence and/or wanton misconduct by the Releasees
3. I, individually, and on behalf of my heirs, successors, assigns and personal representatives,
hereby agree to indemnify, defend and hold harmless the College and its employees, agents,
ofcers, trustees and representatives (in their ofcial and individual capacities) from any and
all liability, loss, damage or expense, including attorney fees, that they or any of them incur
or sustain as a result of any claims, demands, actions, causes of action, damages, judgments,
costs or expenses, including attorneys fees, which arise out of, occur during, or are in any way
connected with my participation in the activity.
4. I hereby consent to receive medical treatment that may be deemed advisable in the event of
injury, accident or illness during this activity or event.
I agree that this Waiver, Release and Indemnication Agreement is to be construed under the
laws of the State of Minnesota, U.S.A.; and that if any portion is held invalid, the balance shall,
notwithstanding, continue in full legal force and effect. I agree that this Agreement is to be
construed broadly to provide a release, indemnication and waiver to the maximum extent
permissible under applicable law.
I acknowledge that to participate in or hold a leadership position within this activity that I must
meet established college and student group eligibility standards and further acknowledge that if I
do not meet these standards that I will voluntarily resign from further involvement until I meet those
standards.
In signing this document I hereby acknowledge that I have read this entire document, that I
understand its terms, that by signing it I am giving up substantial legal rights I might otherwise have,
and that I have signed it knowingly and voluntarily.
With this Service-Learning Agreement, I commit to:
1. Completely fulll my commitment to the community partner for the agreed
length of time and number of hours of service.
2. Arrange a schedule and attend all required trainings with my community partner.
3. Provide transportation for my Service-Learning activities.
4. Maintain condentiality of all information concerning people, clients,
employees, and agencies/organizations. Information I encounter while serving
on-site is private and can only be discussed with site supervisors.
5. Follow community partner policies and guidelines and act in a professional
manner, which may include dress code, respectful speech, and accepting
differences. This also includes notication of absence and participation
expectations.
6. Communicate with the community partner contact, course instructor and/or the
Service-Learning coordinator with concerns or questions related to my
Service-Learning experience.
This document is available in alternative formats to individuals with disabilities by contacting the Director of Access & Disability
Resources at 651.846.1547 or AccessResources@saintpaul.edu.
Saint Paul College is an equal opportunity employer and educator and member of the Minnesota State Colleges and Universities system.
9/18/15
Name of Student Student ID #
Student Signature Date
If you have questions during your Service-Learning experience, please contact your instructor or
Inna Wolfson, Service Learning Coordinator at Saint Paul College.
Inna Wolfson, Service Learning Coordinator
inna.wolfson@saintpaul.edu
325 Marshall Avenue, Room 3420
651.846.1552
Name of Parent/Guardian
Parent/Guardian Signature Date
Required if student is under 18 years of age or a PSEO student.
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