Ride-Along Observer Program Release Form printable pdf download

General Order 1-3, Release

Page 1

RIDE-ALONG OBSERVER PROGRAM RELEASE

In consideration of my receiving permission from the Prince George's County Fire Department to

enter upon the premises of any fire station or related entity, any other premises owned and/or

’

operated and/or used by any fire station within Prince George

s County, and in further

consideration of receiving permission from said Fire Department to participate in a Ride-Along

Observer Program, wherein I will be riding in, on, or upon Fire Department vehicles or using

other apparatus, the undersigned hereby releases the Prince George's County Fire Department,

Prince George's County Police Department, and any and all agents, officers, servants, employees,

attorneys, or other representatives of the foregoing from any and all liability, claims, demands,

actions, and causes of actions, whatsoever, arising out of or related to any loss, property damage,

physical injury, contagious disease, or death that may be sustained by me while, in, on, or upon

any premises, vehicles or apparatus owned, occupied, or used by the foregoing, or which may be

sustained by me while at the scene of any real or apparent emergency situation requiring a

response of the Prince George's County Fire Department, or while commuting to and from the

fire station(s) and other points.

I hereby certify that I am duly aware of the risk and hazards, including serious physical injury or

death, inherent, upon participating in the Ride-Along Observer Program, that such risks and

hazards may exist even in non-emergency situations, and being duly aware of such risks and

hazards, I hereby elect, voluntarily, to participate in the Ride-Along Observer Program. I hereby

assume all risks of loss, damage, and/or injury, including death, that may be sustained by me or

by any of my property while participating in the Ride-Along Observer Program.

This release shall be binding upon my relatives, spouse, heirs, distributees, next of kin,

executors, administrators, and any other interested parties.

In signing this release, I hereby acknowledge and represent:

(a)

that I have read the rules and regulations outlined in General Order 1-3, Ride-Along

Observer Program.

(b)

that I have read this release, understand it , and sign it voluntarily;

(c)

that I am over eighteen (l8) years of age and that I am of sound mind and of sound

physical health;

(d)

that I am not an agent, servant, or employee of the Prince George's County Fire

Department; and

(e)

that any injuries or other damage suffered by me will not be compensable by Worker's

Compensation or any other insurance program maintained by the Prince George's County

Fire Department.

Ride-Along Observer Program Release Form