Social Circle Police Department
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Citizen’s Police Academy Release Form
Waiver and Hold Harmless Agreement
KNOW ALL PERSON(S) BY THESE PRESENTS that the undersigned, being (21) years of age or
older, and laboring under no limitations as to ability contract, does hereby release the CITY OF
SOCIAL CIRCLE, MAYOR, COUNCIL, SOCIAL CIRCLE POLICE DEPARTMENT, and all
elected and appointed officials or employees of said city and department from any liability whatever
as a consequence of any injury to my person, or damage to my property, as a result of said SOCIAL
CIRCLE POLICE DEPARTMENT granting my request to participate in the Citizen’s Police
Academy. I freely and voluntarily accept all risks, and I agree to hold the CITY OF SOCIAL
CIRCLE, MAYOR, COUNCIL, SOCIAL CIRCLE POLICE DEPARTMENT, and all agents and
employees harmless from claim and/or loss of any nature as described above, including, but not
limited to, medical expenses, loss of income, temporary or permanent injury or disability resulting
from injury, pain and suffering, or loss of personal property. I further agree that the CITY OF
SOCIAL CIRCLE, MAYOR, COUNCIL, SOCIAL CIRCLE POLICE DEPARTMENT, nor any
official, agent, or employee owes me any duty whatever about this privilege.
I further agree, that should any person be damaged due to my negligence, I will assume all
responsibility and hold the CITY OF SOCIAL CIRCLE, MAYOR, COUNCIL, SOCIAL CIRCLE
POLICE DEPRTMANT, and/or officials, agents, and employees harmless against claim or loss.
I further agree that I will promptly reimburse for any damages to said facility or equipment.