Date:

Department Name

Team Member 1

Team Member 2

Team Member 3

Main Contact Name

Address

City

State

Phone

Email:

Leader Line Release Form

: I recognize that participating in a Garrison Fire Department sponsored “Extend a Leader Line” contest does have certain hazards and risks involved. I recognize the risks that are involved and release The Garrison Fire Department, Garrison Emergency Services, Garrison Fire Protection Agency, and the City of Garrison from all liability, in the event of any personal injuries or harm that may occur to myself or to any belongings, personal or fire department provided while participating in this activity on August 10th,2019, in the City of Garrison.

I have read and agree to the Leader Line Release Form Information

Signature

Parent Signature (if a Minor)