City of Grove City
Division of Police
Citizen Ride-Along Program
RELEASE
KNOW ALL MEN BY THESE PRESENCE, that I,
for myself, my heirs, executors, administrators and assigns in consideration of the sum of one dollar
($1.00) and other valuable consideration, forever discharge all members and employees of the Grove
City Division of Police, City of Grove City, and State of Ohio, from any and all actions, causes of action,
claims, charges, demands, complaints, damages, injuries, costs, loss of service, expenses and
compensation on account of or arising out of or resulting from an incident occurring during a period of
time commencing on the day of , 20 ,and terminating on the
day of , 20 , while riding in a cruiser operated and owned by
the City of Grove City, Division of Police, or, while participating in any incident with any member or
employee of the Division of Police, City of Grove City, which arises out of or results from my experience
of riding in a Grove City Police Division cruiser and I do hereby covenant with all members and
employees of the Grove City Division of Police, the City of Grove City, and State of Ohio to indemnify
and save them harmless from all actions, causes of action, claims, charges, demands, complaints,
damages, injuries, costs, loss of services, expenses and compensation on account of or arising
out of, or resulting from the aforesaid incidents from the date of these presence.
IN WITNESS WHEREOF,
I have hereunto set my hand this day of , 20 .
Signature
Parent/Guardian
WITNESSES:
Sergeant:
Officer:
45.104 Rev. 2016
