WAIVER OF LIABILITY RELEASE FORM by 3Dq00V

VIEWS: 75 PAGES: 1

									                                           PELHAM
                                      POLICE DEPARTMENT
                                                    14 VILLAGE GREEN
                                             PELHAM, NEW HAMPSHIRE 03076
                                        Telephone (603) 635-2411 Fax (603) 635-6959




   Chief of Police
  Joseph A. Roark




  WAIVER OF LIABILITY RELEASE FORM

I, ______________________________, date of birth, _______________
                     (Please Print)

Do hereby agree that the Town of Pelham, New Hampshire, the Pelham Police
Department and all of its personnel are released from any liability and are in no
way accountable for any injury or physical malfunction which may occur during
my attempt to complete the Pelham Police Department Physical Agility Test.

I understand that I must successfully complete this test before being considered
for employment as a Pelham Police Officer.



______________________________                    ________________
Applicants Signature                              Date

______________________________                     ________________
Witness Signature                                  Date

								
To top