LIABILITY WAIVER
The undersigned being over the age of eighteen (18), do hereby request permission for me or my minor child
to be enrolled in the Knightdale Citizens Police Academy. I agree at all times to obey all instructions, orders,
and commands given to me by any police officer, firefighter, employee, instructor or other agent of the Town
of Knightdale during the time of my participation in this program.
I fully realize and understand that the profession of public safety by its nature is at times dangerous and that I
may be subjecting myself to situations that may result in property damage, injury, or death. Furthermore, I
understand and acknowledge the potential of property damage, injury, or death that may occur as a result of
my participation. Knowing and understanding these risks, I nevertheless freely accept these risks and accept
full responsibility for myself, for any property damage, injury, or death that may occur as a result of the
granting of this request.
In consideration of the educational benefit to be received by me and the granting of this request, I, my heirs,
and my estate, agree to hold harmless, individually and in their official capacity, any and all Town of
Knightdale Police Department officials, employees, and agents from all liability in the event of property
damage, injury, or death sustained by me during my time as a participant of the Knightdale Citizens Police
Academy. I, my heirs, and my estate further agree to hold harmless the Town of Knightdale, North Carolina
and the Town Council individually and in their official capacity from all liability for property damage, injury,
or death sustained by me as a result of the granting of this request.
The inclusive dates and times for this request are today through May 31, 2018.
Print Name: Signature:
Parent / Guardian Signature (if applicable):
Date:
Wake County, North Carolina
I certify that the following person personally appeared before me this day, acknowledging to me that he or
she signed the foregoing document:
_____________________________________ _________________________________
Name of Principal (Parent/Guardian) Signature of Principal (Parent/Guardian)
_____________________________________ _________________________________
Notary Public Name Notary Public Signature
My Commission expires: ________________ Seal:
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