Lock Out Waiver Form

Lock Out Waiver Form

Arcanum Police Department
Location Type*

PropertyVehicle
Property Address*
Date*

MonthDayYear
Date
Hour Minutes
Name*

First NameLast Name
DOB*
Phone Number*
Please enter a valid phone number.
Vehicle Year*
Make*
Model*
Vehicle Plate*
Waiver

I have requested the Arcanum Police Department to attempt to unlock the above listed vehicle or property, which I own or legally possess. I understand that the officer will use an instruments or tools to attempt to unlock my vehicle or property. I realize that the officer may not be able to successfully open the vehicle or property. I also understand that there are several
private providers available to unlock my vehicle or locks.

Furthermore, I understand that there are risks of damage that may occur to my vehicle or locks during this procedure.

I hereby agree to waive all present and future claims for damage, which may occur as a result of my request to have the Arcanum Police Department unlock my vehicle or property.
Signature*

Clear
Email*
example@example.com
Officer*
Last Name and Badge#
Upload Picture of vehicle and plate*

Cancelof
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