v.07.17.
20
[Department/ [DEPARTMENT NAME]
FC Program Liability Waiver
Logo]
The undersigned individual agrees to release, acquit, forgive, and discharge [Department Name]
and any/all related [Department Name] entities and individuals from any actions, claims,
demands, suits, agreements, judgments, liabilities, and proceedings, whether arising in equity or
in law, and in particular arising from:
* The use of any/all of [Department Name] related equipment and/or any activity
relating to Fire Corps or department.
* [Add any additional information if necessary]
This release shall remain binding upon all successors in interest and personal representatives of
the contracting parties, to the extent permitted by law.
Participant’s name (please print)
Participant’s signature Date
Signature of parent or legal guardian (if under 18) Date
For more information contact [Department/Fire Corps Program Name] at
[Email] or [Phone Number].