Release Form

In consideration of the Consolidated City of Indianapolis and Marion County, Indiana (hereinafter referred to as "City") allowing my child/children

(name) __________________________________

to participate in the Indianapolis Fire Department’s "Firefighters Survive Alive" and the Marion County Health Department’s "Safetyville" programs (hereinafter referred to as "programs"), I hereby RELEASE AND DISCHARGE the City,and the City’s departments, agencies, officers, agents and employees from all claims of loss or liability, either direct or consequential, arising out of an accidents, injuries or occurrences associated with my child’s/children’s participation in these programs, whether due in whole or in part to negligent acts or omissions of the City, or the City’s departments, agencies, officers, agents, or employees.

Further, I declare and acknowledge that I am fully aware of the nature and hazards of participation in safety training activities such as those offered in the programs, which may include but are not limited to, climbing stairs, climbing out of simulated windows, crawling down a simulated roof, riding bicycles, rolling on mats and out of a bed, and crawling on the floor.

I have read the above "CONSENT & RELEASE OF LIABILITY" and understand the potential hazards of participation; on behalf of my child/children, and in exchange for their participation in the programs, I hereby accept the risks and responsibilities, and release the City from all liabilities as stated above.

Signature: ____________________________

Printed: _____________________________

Date: _______________________________

To contact the staff or to arrange a tour, click here.
To contact Aleatha Quarles, Director of the Survive Alive Village, click here.