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letter release of liability

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CITY OF GEORGETOWN POLICE DEPARTMENT RELEASE OF LIABILITY Name: ______________________________________ Address: ____________________________________ Drivers License State: ______________ Drivers License #: _________________ Phone: ________________________ Age: _____ (If under 18 years of age, parental approval must be obtained prior to participating in the Ride-Along Program). Reason for Ride-Along: __________________________________________________________ ______________________________________________________________________________ I, __________________________________, do hereby recognize and understand the potential risks associated with participating in the Ride-Along Program and agree to the following terms as stated: 1. I am participating the Ride-Along Program on a voluntary basis. 2. All my heirs, and I, release the City of Georgetown, any employee, agent, or representative of any and all liability. 3. I, and all my heirs, waive the right to all claims, suits, losses or damages against the City of Georgetown, any employee, agent, or representative in both their public and private capacities. 4. I agree this release of liability is intended to be broad and inclusive as is permitted by the laws of the State of Texas, and if any word, term, phrase of clause is held invalid, the remaining balance shall continue in full legal force and effect. I have read, and understand, all the terms of this liability release letter and provide my signature voluntarily. I further understand this release will remain in full effect until the completion of the Ride-Along and all related incidents. SIGNED THIS ________________ DAY OF ______________________________, 20______ SIGNATURE OF PARTICPANT: ________________________________________________ SIGNATURE OF PARENT/GUARDIAN: _________________________________________ SIGNATURE OF WATCH COMMANDER: _______________________________________ OFFICER RIDER APPROVED TO RIDE WITH: __________________________________

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