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6. Full Name:*
8. Email Address*
10. Date of Birth:*
11. Home Address:*
12. Zip:*
14. Phone Number*
15. Occupation:*
16. Driver's License:*
18. Employer:*
19. Employer Address:*
21. Social Security #:*

    The Lancaster Police Department will be conducting a thorough background investigation that may include, but is not limited to criminal History, employment history, and person reference.

22. Sex:*
24. How did you hear about the Citizen Public Safety Academy?*
25. Shirt Size:*

    1. Small
    2. Medium
    3. Large
    4. XL
    5. XXL
27. Other Organizations you are involved with:
29. Have you been arrested or convicted of any crime?*

    If yes , please explain.

31. “I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers. I understand that any omission of false statement on this application shall be sufficient cause for rejection for enrollment in or dismissal from the Lancaster Citizen’s Public Safety Academy.*

    1. I Agree
32. I further understand that the Lancaster Police Department will be conducting a thorough background investigation that may include, but is not limited to: criminal History, employment history, and person reference.”*

    1. I Agree
36. STATE OF TEXAS WAIVER OF LIABILITY, RELEASE, INDEMNIFICATION DALLAS COUNTY AND HOLD HARMLESS AGREEMENT KNOW ALL MEN BY THESE PRESENTS:
38. THAT I, the undersigned, For and in the sole consideration of the privileges of being a participant in the Lancaster Citizen Public Safety Academy of the , and being allowed to use the City of Lancaster property, equipment and services, including but not limited to, the firing range and instruction in self-defense, and recognizing that such activity involves certain inherent risks and dangers to my property and person, to include property damage and/or physical injury do hereby agree to assume the risks attendant to all activities associated with participation in the Citizen Public Safety Academy of the city of Lancaster, including but not limited to: property damage and/or personal injury to me as a result of motor vehicle accidents or motor vehicle collisions on either public streets or private property; property damage and/or personal injury to me as a result of the acts of others associated with any and all Citizen Public Safety Academy activities including the firing range activities and self-defense instruction; property damage and/or personal injury to City of Lancaster property or employees or any third persons resulting from acts of third parties whether caused by error, omissions or negligent acts of said third parties or myself; property damage and/or personal injury to me resulting from my own errors, omissions, or negligent acts of omission, or negligent acts; property damage and/or personal injury to others resulting from my own errors, omissions or negligent acts.*

    1. I Agree
40. I hereby waive all claims, release, indemnify, defend and hold harmless the City of Lancaster and all of its officials, officers, agents, emergency technicians, fire staff, and employees in both their public and private capacities, from any and all liability, claims, suits, demands, expenses of litigation, or cause of action which may arise by reason of injury to persons or loss of, damage to or loss of use of any property occasioned by error, omission, or negligent act of myself or any other persons with regard to this Agreement and I will at my own cost and expense defend and protect the City of Lancaster against any and all claims and demands.*

    1. I Agree
42. I hereby agree to indemnify, defend and hold harmless the City of Lancaster and all of its officials, officers, agents, emergency technicians, fire staff, and employees from and against any and all claims and losses, damages, causes of action, suits, and liability of every kind, including all expenses of litigation, including but not limited to court costs and attorney’s fees for death, injury to or debt of any person or loss of, damage to, or loss of use of any property arising out of or In connection with this Agreement. Such indemnity shall apply whether the claims, losses, damages, causes of action, suits, of liability arise in whole or in part from negligence of the City of Lancaster, of its officials, officers, agents, emergency technicians, fire staff, and employees. It is the express intention of the parties here to, both myself and the City of Lancaster, that the indemnity provided for in this paragraph is indemnity by the undersigned to indemnify and protect the City of Lancaster’s own negligence, whether that negligence is the sole or concurring cause of the injury, death, or damage*

    1. I Agree
44. It is further agreed that the execution of the “Wavier of Liability, Release, Indemnification and Hold Harmless Agreement” Will not constitute a wavier by the City of Lancaster of the defense of governmental immunity where applicable, or any other defense recognized by the courts of the State of Texas
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