Membership Application         6/15/10
                 Names and dates of birth of household members who may be involved in service exchanges.
     NAME(s)                                                        Date(s) of Birth(s)
_________________________________________________________________________      ______________

__________________________________________________________________________      ______________

__________________________________________________________________________      ______________

Address _________________________________________________________ Ann Arbor, 48103 

Phone:_______________________email:__________________________________Date_________

Check the services below which you might offer to other members
and circle those you think you might need:

 ___CARE – Respite,  Illness,  Infant                          ___COMP – Computer Assistance  (type)
 ___DRIVE – Errands, Car Pools                                       ___LESNs - Lessons ( list subject & level)
___L&G– Lawn & Garden Care                                   ___MEALS – Preparation, Sharing
___REP – Simple Home Repairs                                  ___SEW – Sewing, Mending, Knitting         
___S&L  - Snow or Leaf Removal                                      ____SOC – Social (games, music, visit, etc)
___VAC – Vacation Care of Plants, Pets                     ____Other  _____________________
             The Initiation Fee  is $15.00 plus dues of $10.00 per year.  ($5.00 if enrolling after July 1st)  Mail completed application with check payable to  Dexter-Miller Community to: DEXMIL, 2113 Arborview Blvd, Ann Arbor, MI  48103
                            2010 Board of Directors
Nani Barretto         President     616/6341050     aipbarre@umich.edu
Al Feldt                  Secretary       994-1493       alfeldt@umich.edu
Scott Hale                         222-0250        scothale@umich.edu
JoAnn Marcoux     Treasurer       260-2009        jmarcoux@umich.edu
Sally Mitani                                 996-2731        sally@mitanishoeworks.com
Tom Weisskopf    Vice President   929-2899      tomw@umich.edu

                             LIABILITY WAIVER
 IN CONSIDERATION of membership in the DEXTER-MILLER COMMUNITY  and participating in the free exchange of  assistance, goods and services among members (“Activity”)  I, for myself and for personal representatives, assigns, heirs, and next of kin:

   1. ACKNOWLEDGE, agree, and represent that I understand the nature of Exchange Support and Assistance Activities with fellow members and that on occasions I may willingly invite or ask other members to enter into my home and personal property in order to assist me and my household in a variety of  household activities, repairs and needs.  I further agree and warrant that if at any time I believe conditions or activities to be unsafe or damaging , I will immediately discontinue further participation in that Activity by both myself and others acting in my behalf.

    2. FULLY UNDERSTAND THAT: (a) SUCH MUTUAL ASSISTANCE  ACTIVITIES COULD INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY AND/OR PROPERTY DAMAMGE ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation and the assistance provided  by the invited member of the DEXTER-MILLER COMMUNITY

   3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the DEXTER-MILLER COMMUNITY, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT REPAIR OPERATIONS.  AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.

I have read this agreement, fully understand its terms, understand that I give up substantial rights by
signing it and sign it freely and without inducement or assurance of any nature and intend it to be a
complete and unconditional release of all liability to the greatest extent allowed by law and agree that
if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in
full force and effect.
Participant:s printed name                                           Participant’s signature 
  ______________________________________            ______________________________________
  ______________________________________            ______________________________________
_____________________________________            ______________________________________ Street Address                                                             Phone
__________________________________                      __________________________
Ann Arbor, MI  48103                                        Date      ___________________

 

Parent or Guardian of  participants under 18 years of age,  must also complete the following additional Release.   side.

                TO BE COMPLETED  IF  PARTICIPANT IS UNDER 18 YEARS OF AGE
                                     MINOR RELEASE
     AND I,    __________________________’S  PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF DEXTER-MILLER COMMUNITY ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

  __________________________________________            ________________________________
        Printed Name of Parent/Guardian:                                               Signature of Parent/Guardian
__________________________________________            _______________________­­­­­­­­­­­_________

Street Address: _____________________________________
                           ANN ARBOR, MI   48103                                   Date __________________________

       Initiation Fee is $15.00.     Dues are $10.00 per year,  ($5.00 if enrolling after June 21st)
Mail completed application with a check payable to  Dexter-Miller.Community to:
    DEXMIL, 2113 Arborview Blvd, Ann Arbor, MI  48103   If paying the fees is a problem
for you, enclose a statement describing your circumstances to be considered for  a fellowoship.. 

For comments, questions, or more information complete the form below