Liability Release Form Police Department printable pdf download

Liability Release Form Police Department

TOWNSHIP OF GALLOWAY

POLICE DEPARTMENT

_________________________________________________

300 E. JIMMIE LEEDS ROAD, GALLOWAY, N.J. 08205

Patrick S. Moran

(609) 652-3705

FAX: (609) 652-5710

Chief of Police

COSAP Unit

Community Oriented Services

Area Partnership

LIABILITY RELEASE FORM

It shall be formally recognized that I, ____________________________, do

hereby release from liability the Township of Galloway, and any of its

departments

subdivisions,

officers,

agents,

representatives

employees from any civil damages resulting from my participation in the

Etch ‘N Catch Program caused by the use of any materials suggested or

offered from the Township of Galloway. I understand that participation in

the program is voluntary on my part and that any alterations to any

property may alter its operation, function, and value. My use of materials

suggested or offered shall be implemented to place identifying marks on

my property to the best of my discretion understanding that the Township

of Galloway will not be held liable or responsible for my actions.

I sign this Liability Release Form freely and voluntarily, under no coercion

from any representative of the Township of Galloway, and I wish to

continue with the Etch ‘N Catch Program understanding that this is a

community service program based entirely on my participation and

discretion. All of the information I am about to provide to the Galloway

Township Police Department is factual, and any false statements are

subject to criminal liability as set forth in by law.

____________________________

______________

(Signature)

(Date)

POLICE USE ONLY

POLICE CASE #___________________

ENC-1

Revised 09/08

Liability Release Form Police Department