Full Text
CITY OF ARVADA LOCK BOX PROGRAM RESIDENT INFORMATION SHEET COMPLETE AND RETURN TO: ARVADA FIRE PROTECTION DISTRICT- 7903 ALLISON WAY OR ARVADA POLICE DEPARTMENT- 8101 RALSTON ROAD NAME: DATE OF BIRTH: ADDRESS: PHONE: LOCKBOX LOCATION: LOCKBOX COMBINATION: RESIDENT MEDICAL CONCERNS: RESIDENT PHYSICAL NEEDS: FILE OF LIFE YES NO LIFE ALERT ALARM YES NO HOME ALARM YES NO PETS: EMERGENCY CONTACT: FOR CITY OF ARVADA USE ONLY DATE OF JEFFCOM CAD ENTRY: ENTERED BY: ---PAGE BREAK--- CITY OF ARVADA LOCK BOX PROGRAM RELEASE BY RESIDENT (or RESIDENT/OWNER) This Release is executed this day of by the undersigned as owner and/or resident of property located at Arvada, Colorado (hereinafter “Releasor”), and the City of Arvada, a Colorado municipal corporation, 8101 Ralston Road, Arvada, Colorado 80002 (hereinafter “Arvada”). I, Releasor, being of lawful age, in consideration of being permitted to participate in the Arvada Police Department (“APD”) Lock Box Program, the value of which I acknowledge, do, for myself, my heirs, executors, administrators, and assigns, hereby release and forever discharge Arvada, its employees, agents, officers, and representatives from any and every claim, demand, action, or right of action, of whatever kind or nature, either in law or in equity, arising from or by reason of any bodily injury or personal injuries known or unknown, death, or property damage resulting from any act which may occur as a result of participation in the Lock Box Program, or any activities in connection with the Lock Box Program, whether such action is caused or initiated by agents, employees, officers, or representatives of Arvada, or by third parties known or unknown to Releasor or Arvada. Releasor expressly authorizes APD officers and Arvada Fire Protection District (“AFPD”) personnel, to include emergency medical technicians and/or paramedic responders (collectively, “First Responders”) to enter Releasor’s residence in response to any reasonable concern they may have related to Releasor’s safety or medical condition. Releasor further releases all First Responder personnel from any claim whatsoever arising from any first aid, treatment, or service rendered to Releasor or any occupant of Releasor’s property. Releasor understands and agrees that, in order to participate in the Lock Box Program, Releasor is responsible to obtain a passcode-enabled lock box, which utilizes a code to access its contents, at Releasor’s sole expense. Releasor will provide the APD/AFPD with Releasor’s lock box passcode to be entered into the Jefferson County communications center’s computer-aided dispatch (“CAD”) database for access by First Responders for the sole purpose of entering Releasor’s property to render aid. Releasor may, at his or her sole discretion, also provide the APD/AFPD with passcode(s) to other security devices at Releasor’s property (such as garage door openers or electronic locks) to be included in the CAD database for use in the Lock Box Program. Releasor understands and agrees that this Release and Releasor’s participation in the Lock Box Program does not create any affirmative special duty for any First Responder to render aid to Releasor under any circumstances. RELEASOR IS SOLELY RESPONSIBLE TO ENSURE PROPER OPERATION OF RELEASOR’S LOCK BOX, AND FOR THE ACCURACY AND FUNCTIONALITY OF ANY PASSCODES PROVIDED TO THE APD FOR THE LOCK BOX PROGRAM. FIRST RESPONDERS SHALL NOT BE LIABLE UNDER ANY CIRCUMSTANCES FOR ANY MALFUNCTION OF RELEASOR’S LOCK BOX OR ANY PASSCODE FAILURE OR PASSCODE ENTRY ERROR OF ANY KIND RELATED TO ANY LOCK BOX OR PASSCODE PROVIDED TO THE APD BY RELEASOR. This Release contains the entire agreement between the parties hereto. The terms of this Release are contractual and not a mere recital. Releasor understands and agrees this Release shall inure to the benefit of, and be binding upon, the parties, their respective legal representatives, successors, heirs, and assigns. ---PAGE BREAK--- Releasor further states that he/she has carefully read the foregoing Release and knows the contents thereof and signs this Release as his/her own free act, with full knowledge of its significance. In witness whereof, Releasor has executed this Release on the day and year first written above. RELEASOR Signature By: (please print) (please indicate) Owner/Resident or Resident only Owner address: Phone Number: WITNESS: Signature By: (please print) Rev. 11-30-2021