Explorer Waiver of Liability Form

Name:*

Adult or Minor*

Parent or Guardian Name: (if applicable)

Consent Waiver

I hereby state that as a Muscatine Police Explorer, I am aware of the risks and dangers inherent with riding along with a member of the Muscatine Police Department. By my signature, I hereby release the City of Muscatine, it's employee's, agents, officials (elected or appointed), and insurance providers from any and all responsibility and or liability should I be injured in any way while participating in a police ride-a-long program

Parental Consent Waiver

Further, this waiver must be co-signed by a parent or legal guardian of any minor (under the age of 18) wishing to participate in any ride-a-long. By signing this agreement, the parent or guardian of said minor does hereby agree to not hold the City of Muscatine, it's employee's, agents, officials (elected or appointed), and insurance providers from any and all responsibility and or liability should said minor be injured in any way while participating in a ride-a-long with a member of the Muscatine Police Department.

I agree with the above statement.*

Yes

No

Explorer Signature:___________________________________________

Parent/Guardian:_____________________________________________

Date:______________________________________________________