IU Guidelines for Managing Risk in Community Service and Service-Learning Programs
and
R494 Internship Consent Form (1/07)

Disclosure & Disclaimer: IUPUI University Policy Regarding Student Volunteers

IUPUI, and any office or program thereof, is not responsible for pre-qualifying or training students for any service activity that may take place within or beyond the boundaries of the University, and makes no representation as to the abilities or qualifications of IUPUI students. Screening as to suitability for service work and training for that work is the sole responsibility of the organization with whom students volunteer or work.  Since IUPUI does not exercise any supervision or control over student volunteers or students employed by community agencies, liability for their actions at the agency is not imputable to IUPUI, but rather is a matter between the agency and individual students. Only a few schools at IUPUI provide limited liability insurance to protect students from claims arising out of activities undertaken for course credit, practicum or degree requirements, such as nursing students or social work interns. Note that students who undertake community service activities on their own or in connection with service learning courses are not covered under the University policy.
 
Since IUPUI insurance does not cover students going to or from community sites or while volunteering in the community the best route to minimize risk is to:

• provide adequate information about student duties

• be honest in all communication

• be thorough in all preparation up front

• provide clear information about safety precautions

• give students clear directions to follow in case of emergencies

Some agencies have student volunteers sign an Informed Consent form, specifying the agency’s insurance policy’s coverage for volunteers.  A sample Informed Consent form is in Appendix E.  Informed consent forms should detail the potential risks associated with volunteer activity and provide as much information about those risks as possible for volunteers.

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I hereby acknowledge that participation in ___________________________ as a potentially hazardous activity, and that I should
not participate in this event unless I am medically and physically able to do so.

I understand that certain risks are inherent in any service activity and I fully accept all risks associated with my voluntary participation in this event. These risks may include but are not limited to ____________________________________________________________________________

______________________________________________________________________________and those risks normally associated with travel to and from community sites, including catastrophic injury or death.

I understand that I am required to provide my own health and accident insurance. Neither the Trustees of Indiana University nor the staff of the IUPUI Center for Service and Learning is responsible for any medical or legal expenses that may result from any injury or illness sustained while participating in community service/service learning.

I hereby authorize the use and reproduction, without compensation to me, of all photographs taken during this event for the purpose of promoting service activities.

ALL VOLUNTEERS MUST SIGN BELOW BEFORE PARTICIPATING IN EVENT:

Participant’s signature____________________________________ Date____________________

Participant’s name (please print)____________________________________________________

Campus/Home address___________________________________________________________

Phone______________________                                                E-mail_____________________

Person to contact in case of emergency:

Name____________________________________________ Relationship____________________________

Phone ___________________________________________ Address__________________________________________

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