WOODSTOCK POLICE DEPARTMENT
SENIOR CITIZEN CALL-IN PROGRAM WAIVER FORM
As a Senior Citizen residing within the corporate limits of the City of Woodstock I would like to
participate in the Woodstock Police Department Senior Citizen Call-In Program.
I have had the Program explained to me, and I understand that I must call the Police Department
Communications Center each and every morning, unless I have properly notified the Police
Department in writing of my scheduled absence. Should I fail to do so, the Communications
Operator will begin follow-up procedures which include calling my residence and, should there
be no response, send a Police Officer to check on my well-being.
Being of sound mind, I hereby Waive and Release from any liability the City of Woodstock
and its officers, employees, and corporate authorities for any all claims which I, and my
successors, heirs and assignees may have against the Woodstock Police Department, the
City of Woodstock, or any of its employees in connection with my participation in the
Woodstock Police Department Senior Citizen Call-In Program; including, but not limited
to, claims relating to the inability of, or failure by the Police Department to contact me or
ascertain my well-being, any damage if entry to my residence requires force, and to the
possession of my residence key should I have given it as part of the Program. I hereby
authorize the City of Woodstock and its Police Department to enter my residence to
ascertain my well-being if necessary, including through the use of reasonable force.
I understand too, that I can terminate my participation in the Program at any time by providing
property notice of same.
Signed: _____________________________________________
Date: _________________________
Witness: _____________________________________________
