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CITY OF MYRTLE BEACH

POLICE DEPARTMENT
I, __________________________________, am applying to participate in a physical activity
with the Police Department of the City of Myrtle Beach, as part of a training program. As the
undersigned guardian or parent, or as the participant of adult age, I understand that the City does
not require participation in any way, but I personally want to do so, or want my minor child to do
so despite the possible heath, medical injury and accident risks that are widely known when any
one participates in any physical activity or program related to law enforcement. I understand that
all activities in the training and practice of law enforcement are inherently dangerous, but I
affirm through my own determination that due and proper care will be exercised by those who
have oversight over the physical activity.
As a sober and competent adult, I am aware that activity in which I or my child may be engaged
require a person to be of sound mind, and in good physical condition, and I affirm that I have
performed personal due diligence and made the determination that such requirements are met. I
have been adequately warned that injury or death could result in participation in physical activity
through unforeseen circumstances or unknown physical conditions. Even so informed, I
knowingly and voluntarily agree to accept any and all the risks of injury, on behalf of myself or
my minor child. I know that all facets of law enforcement are inherently dangerous, and I
voluntarily assume that risk of injury or death.
I do further agree to hold the Chief of Police, the City of Myrtle Beach, its agents, employees
and contractors completely blameless and free from any and all liability in any proceeding that
may result from injuries sustained during participation in this program. I will bring no claim or
suit. I release, and covenant not to sue the City and all of its officials, agents, employees,
volunteers or contractors (the City), from any and all claims, demands, suits, judgments,
damages, actions and liabilities of every name and nature whatsoever, whenever occurring,
whether known or unknown, contingent or fixed, at law or in equity, that I or those under my
legal custody may suffer at any time arising from or in connection with this participation,
including any injury or harm to me, to those over whom I have legal custody, any death, or
damage to any property. I personally agree to defend, indemnify, and save the City harmless
from and against any and all liabilities arising from this activity.

CITY OF MYRTLE BEACH


POLICE DEPARTMENT
I understand that this is a legally binding Release, Waiver, Discharge and Covenant Not to Sue
made voluntarily by me, the undersigned on my own behalf, my heirs, executors, administrators,
legal representatives and assigns.
I have read this entire Release, I fully understand the entire Release and acknowledge that
I have had the opportunity to review the Release with an attorney of my choosing if I so
desire, and I agree to be legally bound by this Release. I understand this is not an
employment contract.
THIS IS A RELEASE OF LEGAL RIGHTS, SO READ CAREFULLY AND UNDERSTAND BEFORE SIGNING.

______________________________

(Participants Signature and date of birth)

_______________________________ (Parents Signature, if Participant has not achieved the (18

th)

eighteenth birthday)

Notary
State of South Carolina
County of Horry
The signature(s) immediately above were signed and sworn to before me this ________ day of
__________________, in the year 20___.
NOTARY PUBLIC AND SEAL
MY COMMISSION EXPIRES __________________________________________________

Notary, Photo ID, Signature, and Age of Participant verified by Police Department staff on date
_______________________.
___________________________________________________
(Print Name & Signature)