Community Outreach Day is UH-Clear Lake’s official “day of service”, during which students, faculty, staff, alumni and community members join forces and volunteer at a number of service organization sites within the Houston-Galveston community. Service Projects This Semester Include: Habitat for Humanity (Baytown) Houston Food Bank Mountbatten House (Assisted Living – seniors) Hope Village Interfaith Caring Ministries Resale Shop League City Animal Shelter Communities in Schools – Bay Clear Brook High School Descendants of Olivewood (oldest African American cemetery in Houston) Please REGISTER ASAP, as spots are limited per project. Carpooling available. If you would like to volunteer for Community Outreach Day, please register online at or in-person at the Student Life Office, located in the SSCB For info about upcoming service projects and ongoing volunteer opportunities both on-campus and in the community, please visit us on the web! Communi ty Outreach Day Saturday, Sept. 25, 2010 Saturday, Sept. 25, 2010 Times vary per project. See website for details.

Saturday, September 25 Community Outreach Day Registration Form Please print legibly. (Please register only one person per form.) Name: ___________________________________________________________________________ Student ID #: ____________________ Address: ____________________________________ Home Phone #:________________________ Major: _____________________________________ Please Circle One: Undergraduate Graduate Staff Faculty Alumni Family member/friend Please ONLY SIGN UP FOR ONE PROJECT. *Must have own transportation. Carpooling is available. Maps will be available in the Student Life Office one week prior to event. Baytown Habitat for Humanity (8am – 12pm) Building a home. Hope Village (8am – 12pm) Painting, power-washing, cleaning, organizing developmental center. Houston Food Bank (8:30am – 11:30am)  Limited transportation will be provided for this event. Herztein warehouse facility. Communities in Schools – Bay Clear Brook High School (8am – 1pm) “Room to Grow” project. Preparing and installing gardens into one of CBHS’s Atrium areas to enhance learning environment which will be utilized by environmental and science students. Water and lunch will be provided. Interfaith Caring Ministries Resale Shop (11am – 2pm) Sort, straighten, price merchandise, help customers and a variety of other jobs. Must be at least 16. Located on Bay Area Blvd. Mountbatten House (12:30pm – 4pm) Mountbatten House is an Assisted Living home for seniors located in Highlands, Texas. Volunteers will help prepare and serve an afternoon tea for a 100 th birthday celebration for one of MBH’s residents. Will also assist in fun activities with residents and special guests. League City Animal Shelter (10am – 2pm) Dog wash, socialize animals at shelter. Descendants of Olivewood (9am – 12pm) Olivewood is the oldest incorporated African-American cemetery in Houston. Volunteers will help to clear brush, mow grass and rake leaves to help clean up the cemetery and restore it. Olivewood is located in the First Ward area near I-10 and Studemont. Any person requiring an accommodation for a disability in order to participate in this event should contact Jennifer Clark at (281) at least one week in advance of the program. Please return this registration form AND ATTACHED WAIVERS to the Student Life Office. You must complete the appropriate waiver form(s) before participating in project. (We strongly encourage you to do this at the same time you register for the project.)  WE NEED YOUR HELP! PLEASE CONSIDER HELPING US CARPOOL! If you are willing to drive other volunteers to the project you have registered for, please check this box. Please note: for legal reasons, the Student Life Office will need to obtain a photocopy of your proof of car insurance if you are driving for this event. _____ Yes, I am willing to drive volunteers to my project.

Form No. OGC-S UNIVERSITY OF HOUSTON – CLEAR LAKE RELEASE AND INDEMNIFICATION AGREEMENT FOR ADULT STUDENTS STUDENT (Name and Address)INSTITUTION: _____________University of Houston – Clear Lake_ ___________________________________________2700 Bay Area Blvd. ___________________________________________Houston, Texas DESCRIPTION OF ACTIVITY OR TRIP: Community Service Outreach Day – day of service LOCATION: (Name of project) DATE(s): Saturday, September 25, 2010 I, the above-named Student, am eighteen years of age or older and have voluntarily applied to participate in the above Activity or Trip. I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury, or death, and I understand and appreciate the nature of such hazards and risks. I represent that I am physically able, with or without accommodation, to participate in the above-referenced Activity or Trip, am able to use the equipment and/or supplies associated with the Activity or Trip, and have obtained all required immunizations. In consideration of my participation in the Activity or Trip, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release the above named Institution, its governing board, officers, employees, and representatives from any and all liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity or Trip, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity or Trip. I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. Should I require emergency medical treatment as a result of accident or illness arising during the Activity or Trip, I consent to such treatment. I acknowledge that the University of Houston does not provide health and accident insurance for participants in the Activity or Trip and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I acknowledge that I have been given the option to purchase insurance for the Activity or Trip through the University. I will notify University representatives in writing if I have medical conditions about which emergency medical personnel should be informed. _____________________________________________________________________________________ Signature of Student Signature of Witness _____________________________________________________________________________________Date Signed Note: To request disability accommodations for this Activity or Trip, please contact [the Center for Students with Disabilities at least 10 days in advance of the Activity or Trip by calling (713) (voice); (713) (TTY); (713) (FAX).] OGC Form No. S-98-20: Approved for use as a Standard Agreement by the University of Houston System Office of the General Counsel 8/31/98 Note: Modification of this Form requires approval of OGC

RELEASE AND WAIVER OF LIABILITY The undersigned, who is participating in a university-sponsored community service project at (Name of Project) __________________________on Saturday, September 25, 2010, do hereby: Release and forever discharge the University of Houston – Clear Lake and the University of Houston System, its members individually, and its officers, agents, and employees, of any and all claims, demands, rights and causes of action of whatever kind, arising from and by reason of any or all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, resulting from my participation or in any way connected with this event. SIGNED this __________ day of _____________________, ______________________________________________________ Signature ______________________________________________________ Printed Name ______________________________________________________ Emergency Contact Person (Printed Name) ______________________________________________________ Emergency Contact Person (Phone Number(s)) Sponsor: UHCL Student Leadership, Involvement and Community Engagement (SLICE) program One copy of this completed form will be carried by staff advisors on this trip and one copy will be left with staff at the university.

Authorization for Use of Photograph or Likeness I, (printed name) __________________________________________, do hereby permit and authorize the University of Houston-Clear Lake, the University of Houston System and its components, employees, agents and other personnel who are acting on behalf of the system to use my photograph or other likeness for purposes related to the educational mission of the system, including publicity, marketing and promotion of the system and its components. I understand my photograph may be copied and distributed by means of various media, including publications, video presentation, television, news releases, mail outs, billboards or signs, brochures or Web sites. I understand that, although the University of Houston-Clear Lake, the University of Houston System and its components will endeavor to use my photograph in accordance with standards of good judgment, the University of Houston-Clear Lake cannot guarantee that any further dissemination of my photograph or likeness will be subject to system supervision or control. Accordingly, I release the University of Houston-Clear Lake from any and all liability related to dissemination of my photograph or likeness. I have read this document and understand its contents. _______________________________________________ ___________________ Signature of Subject (If subject is a minor child, a guardian Date must sign this form and indicate relationship to child.) _______________________________________________ ______________________________ Address Telephone _______________________________________________ ______________________________ City, State, ZIP Address _______________________________________________ ___________________ Signature of photographer, on behalf of the University of Date Houston-Clear Lake