Basic Training Process For Waiver Officers Registration Form printable pdf download

Registration Form: Basic Training Process for

Registrant’s Information

Waiver Officers

Please Print Information:

Registrant’s Name: _____________________________________________ DOB: ____/____/_______

Last

First

Middle

Last 4 Digits of SSN: __________________ Contact Email: ___________________________________

Home

Home Address: __________________________________ Contact Number: __________________

Cell

Work

(Street, City, State, and Zip)

Sponsoring Agency: _________________________________ Caliber of Duty Ammunition: __________

Agency Contact: ___________________________

Agency Phone Number: ___________________

Course Dates: ________________________________ Registrant is Commuting:

OR Overnight:

Registrant: Release of Liability

This release is made by _________________________________, DOB: ______________________

of the Town of __________________, County of _____________, State of _____________________.

I, on my behalf and on behalf of my heirs, next of kin, executors, administrators, estate, agents and assigns, and

representatives of any nature whatsoever, for and in consideration of being a student of the Vermont Police Academy

do hereby waive, release, and hold harmless the State of Vermont, the Vermont Criminal Justice Training Council, the

Vermont Police Academy, and all of their agents, employees, former employees, and representatives from all

demands, damages, actions, causes of action, suits and claims of any nature whatsoever, that I or my heirs, next of

kin, executors, administrators, estate, agents, and assigns and representatives of any nature whatsoever, might

otherwise have on account of death, physical or mental injuries, both to person and to property, whether foreseeable

or not, which may occur, directly or indirectly, or develop at any time in the future, as a result of my activities and

association in the firearms class and all other instruction and participation in the activities of the Vermont Police

Academy.

I, the undersigned, have read this release in its entirety and understand all its terms. I execute it voluntarily and

with full knowledge of its significance. In witness whereof, I have executed this release on

this _____________day of ______________________________, in the year of ___________________.

_______________________________________________________

Signature of Registrant

At Town of ______________________, County of _____________________ State of _______________,

personally appeared and acknowledged the above instrument, sealed and subscribed by him/her, to be his/her

own free act and deed and made with full knowledge of its significance.

Before me, _____________________________________________

Notary Public (exp: ________________)

VCJTC, Registration for Basic Training Process for Waiver Officers, Rev, 12/14

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Basic Training Process For Waiver Officers Registration Form