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MISSOULA POLICE DEPARTMENT WAIVER OF LIABILITY READ THIS CAREFULLY BEFORE SIGNING I, do hereby state and affirm: 1. That I desire to participate in the citizen observer program operated by the Police Department of the City of Missoula; 2. That I understand that as an observer I will be riding in police cars with on-duty police officers who will be involved in various law enforcement activities; 3. That I understand that such activities can be very hazardous, and that I may be placed in hazardous situations, including but not limited to high-speed pursuits, arrests, fights and other dangerous events; 4. That I will comply fully with all requests of Police Department personnel during the course of my participation in the Citizen Observer Program in order to minimize the risks involved and avoid hindering law enforcement activities; that I understand that I may be asked to get out of the police vehicle at any location in the City, in the event of an emergency. 5. That I understand my participation in the citizen observer program is contingent upon the results of a record check. THEREFORE, in consideration of being given the opportunity of observing police operations by riding in a vehicle operated by members of the Missoula Police Department, I recognize and assume all risks pertaining to the Citizen Observer Program and I hereby release the City of Missoula, the Missoula Police Department, all police officers employed by the City of Missoula, and all officials and personnel of the City of Missoula from any and all liability whatsoever for any injuries or damages that I, my heirs and devisees, dependents and assigns may sustain in any way during the course of my participation in the Citizen Observer Program. I hereby certify that I have read the above statements and understand them, and that I intend to be legally bound thereby. Dated this day of , . Observer’s Signature: Observer’s Telephone Number: The following information is necessary to complete the record check required for participation in the Citizen Observer Program. PRINT LEGIBLY Name: Last First Middle Maiden or Alias Address: Street City State Zip Code Date of Birth: Place of Birth: Sex: Race: Social Security Number: Citizen Observers – Do Not Write in the Box Below Does participant have a Police Record? Yes No Record check completed by: Officer Observer to ride with: Car Patrol Supervisor: Cancelled by: Reason for cancellation: Observers under the age of 18 must complete both sides of this form! Observers under the age of 18 must complete both sides of this form. ---PAGE BREAK--- If the Citizen Observer is under the age of eighteen (18) years of age, the signature of a parent or guardian is required below. I, , certify that I am the parent or guardian of the citizen observer named on the reverse side of this form, that I consent to his/her participation in the Citizen Observer Program, that I have read the information written on the reverse side of this form and that I hereby acknowledge that the release and waiver of liability shall apply to me and all others sharing legal guardianship of the citizen observer to the extent that it applies to the Citizen Observer. Parent/Guardian Signature Address City State Zip Telephone Number Witnessed by: Date Witnessed: OR Subscribed and sworn to before me this day of , Notary Public for the State of Montana Residing in: My commission expires: The parent or guardian must sign this form before a Notary Public or before an employee of the Missoula Police Department. SEAL