Sebastian Police

Subscriber’s Name:

The undersigned as a condition to participation in the Sebastian Police Department RUOK Program (hereinafter “Program”) hereby agrees to indemnify and hold harmless the Sebastian Police Department, the City of Sebastian, Florida, its council members, directors, officers, employees, partners, principals, contractors, agents, representatives, volunteers, and each of them, against any and all administrative and judicial proceedings and orders, charges, claims, costs, damages, demands, expenses, fines, judgments, liabilities, losses, penalties, and remedial actions of any kind and all other related costs, damages, demands, expenses, fines, judgments, liabilities, losses, penalties, and remedial actions of any kind and all other related costs and expenses incurred in connection therewith, including, but not limited to reasonable attorneys’ fees and the cost of defense arising out of injury to persons, including but not limited to death, or damage to property, caused by, directly or indirectly, in whole or part, or in any way connected with the Subscriber’s participation in this Program. The subscriber acknowledges that technical difficulties, weather conditions and other unforeseen situations may result in failure of the services provided by the Program at any time. Further more, the subscriber must notify the Sebastian Police Department in a timely manner if they will not be at their residence at the time of their regularly scheduled daily telephone call. Failure to notify the Department may result in officers forcibly entering your residence to check on your welfare.

Date: Subscriber:________________________________________
(signature)

Witness:____________________________________________________________________

Acknowledged Before me this ________Day of ________________, 20______,

By______________________________ who is ( ) personally known to me OR ( ) who produced

_____________________________________ as identification.

__________________________________ Commission Expires________________________
Notary Public

In-house ( Hold Harmless RUOK Form B-6 Revised 9/06)

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