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5 <br />Ride Along Program Application <br /> <br /> <br />Name: <br /> <br />Phone Number: <br /> <br />Date of Birth: <br /> <br />Address: <br /> <br />Purpose for Ride along: <br /> <br />Employer/School <br /> <br />Being of lawful age and of sound mind, for myself and my heirs, administrators, executors and <br />assigns, hereby assume all risk in all activities in which I participate, and in this program waive <br />the right to assert my claim, action or cause of action, whatsoever, against the City of Hugo or <br />its employees for an injury, loss or damage whatsoever, to my person and/or personal property <br />in my possession, including injuries resulting in death, arising out of any accidents or events <br />occurring while I am riding as a passenger in a City of Hugo Building Department vehicle and/or <br />accompanying City of Hugo Building Inspectors in the performance of their duties, unless <br />caused by the gross negligence or intentional torts of the city. <br />I am aware that circumstances, events, dangers or hazards may arise or occur while I am a <br />passenger in such city vehicles, and/or accompanying such Building Inspectors that could <br />expose me to harm and may result in personal injury, loss, damage or death as aforesaid, and I <br />assume the risk of such known or unknown circumstances, events, dangers, or hazards, <br />whether reasonably foreseeable or not. <br /> <br />I further agree to save [?] and hold the City of Hugo harmless from any and all claims that may <br />arise or are attributable director or indirectly to me in conjunction with my participation with <br />the City of Hugo’s Building Department. <br /> <br />I have read the above, and I fully understand the legal significance of my signature, and I have <br />received a copy of this waiver. <br /> <br />Signed: <br /> <br />Spouse: <br /> <br /> <br /> <br />