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2. ASSUMING RISK OF INJURY OR DAMAGE WAIVER AND RELEASE OF CLAIMS AND INDEMNITY AGREEMENT
   The purpose of this program is to allow interested persons to ride on a departmental unit with Franklin County Public Safety personnel. The program is designed to increase awareness of the Franklin County Public Safety emergency services through direct contact with the EMS and suppression personnel and their work at the scene of an accident, illness, fire or other incident.
   
   Candidates for the program should at a minimum meet one of the following criteria:
   Have an interest in emergency medical or fire services as a…
   

   • Career (i.e. high school or college student 16 or older, career-changer, etc)
   • Job related educational opportunity
   • Decision maker (i.e. elected official, board member, leadership participant, taxpayer, etc)

   
   I have made a voluntary request to ride in a vehicle assigned, leased, owned, operated, or otherwise in use by the Franklin County Department of Public Safety and/or one of its fire, rescue, or EMS stations. I have also made a voluntary request to accompany personnel during the performance of their official duties. In consideration of the permission given to me to participate in a ride-along program, I do hereby agree:
   
   1. That I am aware that the work of the Department of Public Safety is inherently dangerous and that I may be subjected to the risk of death or personal injury or damage to my property by accompanying personnel during the performance of their official duties and that I freely, voluntarily, and with such knowledge assume the risk of death, personal injury, or property damage arising from or in any way connected with fire, explosion, gas, electrocution, hazardous materials, medical emergencies, or the use of weapons, unlawful acts, or forcible resistance by law violators or suspected law violators, assault, riot, breach of peace while accompanying personnel during the performance of their official duties.
   
   2. That the County of Franklin, Director of Public Safety who serves as Chief of Public Safety for the County of Franklin, his sureties, all personnel of the Department of Public Safety, their sureties, and each of them, shall not be held responsible or liable for any injury, damage, loss or expense, either to me or my property, incurred while riding in any vehicle assigned, leased, owned, operated, or otherwise in use by the Franklin County Department of Public Safety and/or one of its fire, rescue, or EMS stations or while accompanying any personnel of said department during the performance of their official duties and resulting from any negligent act or omission on the part of any personnel of said department.
   
   3. For myself, my heirs, my executors, administrators, and assigns, to release, indemnify, protect, defend, and hold the County of Franklin, the Franklin County Department of Public Safety, and all officers, employees, supervisors, volunteers, and others employed or providing service for said department, harmless from all liability, obligations losses, claims, demands, damages, actions, suits, proceedings, costs, and expenses, including attorney fees, of any kind or nature whatsoever, whether suffered, made, instituted, or asserted by me, my heirs, executors, administrators, and assigns, or by any other entity, party, or person for any personal injury to or death of any person or persons for any loss, damage, or destruction of any property, whether owned by the County of Franklin of not, arising out of, connected with or resulting directly or indirectly from my participation in the ride-along program and which arises by reason of any actual or claims negligent or wrongful act or omission of mine that occurs while riding in any vehicle assigned, leased, owned, operated, or otherwise in use by the Franklin County Department of Public Safety and /or it’s fire, rescue, or EMS stations or in otherwise participating in the ride-along program. The foregoing agreement to indemnify shall continue in full force and effect notwithstanding the conclusion of my participation in the ride-along program.
4. Applicant Name*
5. Applicant Street Address*
7. City*
8. State*
9. Zip Code*
11. Applicant Date of Birth*
    Applicant Date of Birth
12. Applicant Phone Number*
13. Today's Date*
    Today's Date
15. SIGNATURE AREA - PLEASE STOP HERE AND READ. DO NOT FILL OUT!
    Once you submit, this form will be held at the Franklin County Department of Public Safety office. You will need to come in (along with a Parent/Guardian if a minor) to sign the agreement in front of a Public Safety Department witness.
17. Applicant Signature
    
    _________________________________________________________
    
    Date ___________________________
19. Parent/Guardian (if a minor)
    
    _________________________________________________________
    
    Date ___________________________
21. Department Witness
    
    _________________________________________________________
    
    Date ___________________________
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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