| Agreement and Release of Liability I understand and acknowledge that Santa Paula CERT association is a volunteer organization formed to provide assistance in emergency support services for the benefit of law enforcement agencies, fire fighting agencies, public offices, and the general public. I further understand and acknowledge that any activities engaged in by Santa Paula CERT include, but are not limited to the following: disaster response, urban search and rescue operations, basic medical support operations, fund raising activities and general or outside activities which are carried on in places, and under some circumstances placing the participants in dangerous and life threatening situations. I acknowledge that these activities are inherently dangerous activities in which I participate at my own risk, peril and fiscal responsibility, and I assume any and all risks inherent thereto. I hereby, on behalf of myself, my heirs, assigns, and personal representatives and successors waive, release and forever discharge Santa Paula CERT association, officers, directors, members, attorneys, sponsors, promoters, affiliates and any organization associated with Santa Paula CERT from any and all claims, including but not limited to claims for personal injury, property damages or wrongful death, against any such persons, or organizations, arising directly or indirectly from or attributable in any legal way to any action or omission to act of any person or organization in connection with any sponsorship, organization activity, or event, including travel to and from such activity or event in which I may participate. I further understand and acknowledge that all Santa Paula CERT participants, during any activities, may be subject to possible extreme physical exertion and may have limitations or conditions which limit their participation. In consideration therefore, I affirmatively state that I am in good health and have no known physical or mental conditions which would impair my capability for participation in the normal activities of Santa Paula CERT association. I further affirm that I will be familiar with, understand, and practice the operation protocol of Santa Paula CERT association in engaging in the activities herein referred to and covered by this release of liability. I agree for myself, my heirs, assigns, personal representatives and successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my heirs, assigns, personal representatives or successors assert any claim in contravention of this agreement, I or my heirs, assigns, personal representatives or successors shall be liable for all expenses, including legal fees and costs, incurred by the other party or parties in defending such claims, whether an action is filed or not, unless the other party or parties are finally adjudged liable on such claim for willful and wanton conduct. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification or waiver of any other provision herein or as consent to any subsequent waiver or modification. I agree to the terms of the above Agreement and Release of Liability. ____________________________ _____________________________ _________________ Print Name: Signature: Date: Parent of Guardian of a Minor: I, as a parent or guardian represent to Santa Paula CERT that the facts herein contained concerning my child are true. I hereby give my permission for my child to participate in this activity or event conducted by Santa Paula CERT, agree individually and on behalf of my child, to the terms above Agreement and Release of Liability. _____________________________ __________________________________ ____________ Signature of Parent or Guardian Printed Name of Parent or ______________________________ __________________________________ ------------------- Emergency Contact Number Santa Paula CERT Representative Date SP CERT REV/4/11//07 MB |








| In consideration of my acceptance in the Santa Paula Community Emergency Response Team a volunteer organization, I make the following statements, representations and agreements, |



