Emergency Vehicle Assistance Form

1
Date
Date
Year
Month
Day
1
1
2
3
4
5
6
7
8
9
10
11
12
Hour
28
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
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35
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38
39
40
41
42
43
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45
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48
49
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54
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57
58
59
Minutes
PM
AM
PM
2
I hereby release the City of Alabaster and the Police Department, Officials, Employees and the person rendering the assistance from any liability for any damage or injury that may result from the rendering of this request for assistance. No fault may be claimed or implied.
3
Your name
Please enter your name in this field
4
Email AddressThis will be used to send you a confirmation email upon completing of this form
example@example.com
5
Description of Vehicle
6
I understand that the Officer rendering assistance to me is not a trained automobile technician or mechanic, and has no specific training in the area I am requesting service.The Officer is providing the assistance at my request and at no charge.
7
Signature BoxPlease sign below to indicate you accept the Terms and Conditions
Should be Empty: