Medford Junior Police Academy Counselor Registration Form
  • Medford Junior Police Academy Counselor Application

  • Applicant Information

  • Format: (000) 000-0000.
  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Emergency Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Medford Police Department Junior Police Academy

    RELEASE OF CLAIMS, INDEMNITY AND HOLD HARMLESS AGREEMENT

    I, the undersigned parent/guardian, hereby authorize my child to participate in the Medford Police Department Junior Police Academy (the “Program”) located at the Medford High School. I understand that participants in the class will be engaged in various activities, some of which present situations which may be physically and mentally challenging. I acknowledge that it is my/my child’s voluntary choice to participate in the Program, and I hereby release the City of Medford, the Medford Police Department, and any employee, agent, official, attorney, or representative of the Medford Police Department and the City of Medford (the “Releasees”), of any and all liability for any and all claims, actions, causes of action, demands, damages, costs, loss of services, injuries, attorneys’ fees, expenses and compensation which I may have as the result of my child’s voluntary participation in the Program and all activities related thereto.


    I, the undersigned parent/guardian, acknowledge that my child’s participation is voluntary and may expose my child to certain risks, including physical injuries. I therefore assume all risk of injury to my child’s person or property arising from my child’s participation in the Program, and in this regard agree to pay all medical costs or property damage costs occasioned and thereby releasing the City of Medford, and the Medford Police Department and Releasees from and against all claims, damages, injuries, or causes of action which my child and/or my child’s estate may have herein. Furthermore, I hereby agree to protect the City of Medford and its successors, departments, officers, employees, servants, attorneys and agents against any claim for damages, compensation or otherwise arising out of or resulting from any injury to any party in connection with my child’s participation in the aforementioned activities and to INDEMNIFY, reimburse or make good to the Releasees or its successors, departments, officers, employees, servants and agents any loss or damage or costs, including attorneys’ fees, which the City of Medford or its representatives may have to pay if any claims or litigation arises from my child’s participation in the Program.

    I, the undersigned parent/guardian, also give permission for my child to be transported in a Medford Police Department or City of Medford vehicle and understand that the Program involves transportation to different locations. I hereby forever release the Releasees, as well as any other drivers, owners and/or lessees of the vehicles from any and all claims or causes of action and agree that the Releasees are not responsible for any personal injury or property damage that may occur during said transportation involved in the Program.

    I, the undersigned parent/guardian, hereby further covenant for myself, my child, and my child’s estate not to sue the Releasees on account of any such claim, demand or liability.

    I, the undersigned parent/guardian, have read and understand the conditions of this Program as stated above and hereby voluntarily assume all risk of loss, damage, costs or injury to my child or to my child’s property, including death, which my child may sustain while participating in the Program. I am fully aware that by signing this document I am releasing the above-mentioned parties from liability that may arise as a result of intentional or negligent acts of these parties. Additionally, it is my intent to release the above-mentioned parties from liability relating to any accident and resulting injuries, property damage, and/or death that may occur while my child is participating in the program or riding on or near moving vehicles of the Medford Police Department. This release and agreement shall be binding upon me and my heirs, executors, administrators, personal representatives and assigns, and it shall inure to the benefit of the Releasees and their heirs, executors, administrators, personal representatives, assigns and successors in office.

  • Confirmation

    By signing this release, the participant and parent/legal guardian agrees to the consent and release rules listed above.  I or the undersigned parent/legal guardian give permission to have my minor child’s participation in this Program.

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