P1-32a - Ride-Along Program Application Form - Colorado Springs Police Department (Page 3 of 4) in pdf

COLORADO SPRINGS POLICE DEPARTMENT RELEASE AND INDEMNIFICATION AGREEMENT

I, __________________________________, in and for the consideration of the City of Colorado Springs permitting me to ride as an observer

in a Colorado Springs Police vehicle, while such vehicle is used for on-duty police functions, do hereby release and forever discharge and

covenant to hold harmless, for myself and my heirs, personal representatives, administrators, successors and assignees, the City of Colorado

Springs Police Department and any of their officers, agents or employees, any and all other officers, agents or employees, and any and all other

persons, firms and corporation of and from any and all liability for any and all claims, demands, damages, costs, liabilities, losses and causes of

action, which may arise incidental to my accompanying such City employees or agents in such vehicle on any occasion on which I ride as an

observer.

I further understand that police activities, by their very nature, can and will in all probability, involve some danger. I hereby fully assume the

risk for any of the potential dangers which are associated with police patrol activities as a condition to being granted this privilege.

I further agree to fully indemnify the City of Colorado Springs, the Colorado Springs Police Department and any and all of their officers,

agents or employees from any and all third party claims, demands, or causes of action for damages, costs, liability and losses of any kind which

result from an injury due to acts or omissions on my part at any time upon which I am a participant in the Colorado Springs Police Department

Ride-Along Program.

I understand that the privilege and authorization which is granted to me by the approval of this Release and Indemnification Agreement may be

revoked at any moment, if in the opinion of the supervising officer or any Police Department member, my actions constitute a hazard or

hindrance to any aspect of police duties or safety.

I further warrant that no promise or inducement has been offered except as herein set forth that this Release and Indemnification Agreement is

executed without reliance upon any statement or representation by the persons or parties released, or their representatives, concerning the

nature or extent of any potential damages or legal liability therefore.

I warrant that I am legally competent to execute this document. (This paragraph applies only to those 18 years of age or older.)

Dated this _________ day of ____________________, 20____.

__________________________________

(Signed in presence of notary)

State of Colorado

County of El Paso

Sworn to and subscribed before me this _____day of ____________________, 20____.

______________________________________________

Notary Public

______________________________________________

(SEAL)

Notary Address

______________________________________________

Notary Commission Expires

PARENTAL PERMISSION AND AGREEMENT

(Necessary for All Persons Under 18 Years of Age)

I, ____________________________________, am the parent or legal guardian of ______________________________, who is a person under

18 years of age. I have read and understand this release and Indemnification Agreement.

______________________________ has my permission to ride as an observer in a Colorado Springs Police vehicle as provided above. It is

hereby agreed that I am a party to this Release and Indemnification Agreement and that said agreement is binding upon me, said child, and any

and all our legal heirs and successors of whatever kind. I further warrant that I am legally competent to execute this document.

Dated this _________ day of ____________________, 20____.

___________________________________

(Signed in presence of notary)

State of Colorado

County of El Paso

Sworn to and subscribed before me this _____day of ____________________, 20____.

______________________________________________

Notary Public

______________________________________________

(SEAL)

Notary Address

______________________________________________

Notary Commission Expires

P1-32a - Ride-Along Program Application Form - Colorado Springs Police Department Page 3

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