Ride Along Request

Applicant Information

WAIVER AND RELEASE OF LIABILITY AND INDEMNIFICATION FOR USE OF RIDE ALONG PROGRAM

· In consideration of being allowed to participate in the Jefferson City Ride-Along Program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1) There is a risk of injury from the activities involved in this program, including the. potential for serious injury such as permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist;

2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (as defined hereafter) or others, and assume full responsibility for my participation and state that I am of sound health and mind to participate in the activities for which I intend to engage;

3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I realize that being with Fire Department Personnel does not protect me from these or any other dangers;

4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the City of Jefferson, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used during the Ride-Along program ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, · WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law, and

5) To the fullest extent allowed by law, I agree to be financially responsible for any damage caused by me during my time as a ride-along with the Jefferson City Fire Department through my intentional, negligent, or accidental act. In this case, full indemnification shall apply to the replacement cost, and not just the fair market value, of any property, real . or personal and any costs including court costs and attorney fees.incurred by the City of Jefferson to collect said debt.