Clear Brook Volunteer Fire & Rescue, Inc.

General Release Form

Release by individual - from responsibility for participation in inherently dangerous activity.

Release executed on (Date) _____________ by (person requesting to ride apparatus) ___________________________ of

(City) _________________________, County of _____________________________ hereinafter referred to as releaser.

In consideration of being permitted to ride emergency apparatus and respond to calls and in other good and valuable consideration, releaser, for himself and personal representatives, heirs and next of kin, hereby releases, waives, discharges and covenants not to sue Clear Brook Volunteer Fire & Rescue Company, Inc. or the County of Frederick Fire and Rescue Services, its officers, and members, and/or associates, all for the purposes herein referred as releasers, from all liability to the releasor, his personal representatives, assigns, heirs and next of kin for all loss or damage and any claim or damage thereof, or on account of injury to the person or property or resulting in death of the releasor, weather caused by the negligence of the releasees or otherwise while the releasor is riding apparatus, or for any purpose participating in the same activity.

Releasor agrees to indemnify the releasees and each of them from any loss, liability, damage or cost releasees may incur due to the presence of the releasor in or upon the County of Frederick or the City of Winchester, or the County of Berkeley whether caused by negligence of the releasees or otherwise.

Releasor hereby assumes full responsibility for and risk of bodily injury, death or property damage due to negligence of releasees or otherwise while in or upon the apparatus and/or while participating in the same activity.

Releasor expressly agrees that the release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by laws of the Commonwealth of Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Releasor, being of lawful age, in consideration of being permitted to participate in fire and rescue activities, do for myself, my heirs, executers, administrators, and assign. hereby release and forever discharge the Clear Brook Volunteer Fire & Rescue Company, Inc. and the County of Frederick Fire and Rescue Department, their heirs, administrators, executers of and from any and every claim, demand, action or right of action, or whatsoever kind of nature, either law in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death and/or property damage resulting or to result from any accident which may occur as a result of participation in fire and rescue activities or any activities in connection with the same activity, weather by negligence or not.

I further release all officials from any claim whatsoever on account of first aid, treatment or service rendered me during my participation in this activity.

This release contains the entire agreement between parties hereto and terms of the release are contractual and not a recital.

Releasor further states the he/she has carefully read the for forgoing release and knows the content thereof and signs this release and his/her on free act.

In witness whereof, releasor has executed this release at (time) _____________, the day and year first above written.

____________________________________________            ______________________________________     Signature                                                                           Witness