Memorandum of Understanding
I, (print name)__________________________________________, hereby request to
participate in the Newport News, Virginia Community Emergency Response Team (CERT)
program. I understand that this training will involve active physical participation, which
includes a potential risk of personal injury and/or personal property damage. I make this
request with full knowledge of the possibility of personal injury and/or property damage.
Further, I have read and understand the program outline that describes all class sections
and the associated activities.
I understand that participation in the CERT program may carry a risk of personal injury
and/or property damage. I further understand that I may encounter natural and manmade
hazards, environmental conditions, diseases and other risks that may result in injury to
my person or property. My participation in the CERT program is voluntary. I do hereby
agree to assume all risks which may be associated with or result from my participation in
this program, and hereby waive any and all claims, causes of action and demands
against the City of Newport News, its agents, officers and employees for any personal
injury or property damage arising from my participation in the CERT program.
I agree to follow the rules established by the instructors, and to exercise reasonable care
while participating in the CERT program. I understand that if I fail to follow the
instructor’s rules and program regulations or if I fail to exercise reasonable care, I can be
administratively removed from the program. I understand that I do not become an
employee of the City of Newport News via my participation in the CERT program.
By executing this agreement I certify that I have read this agreement in its entirety,
understand all of its terms and have had any questions regarding this agreement or its
effect satisfactorily answered. I sign this release freely and voluntarily.
____________________________________ _______________________________
Signature Date Print Name
____________________________________ _______________________________
Daytime Telephone Address
____________________________________ _______________________________
Emergency Contact Name Emergency Contact Number
E-Mail Address: _______________________________________________________
