Public Safety Department

RELEASE OF LIABILITY

READ CAREFULLY – THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for the service of Jump Starting of Motor Vehicle by Northern Essex Community College

and Eagle Investigation Services, Inc. (“NECC & EIS”), of 100 Elliot Street Haverhill, Massachusetts,

01830. I agree for myself and (if applicable) for the members of my family, to the following:

1. I recognize that there are certain inherent risks associated with the jump starting of a motor vehicle

and I do hereby waive any and all liability for personal injury and/or property damages that may

result from assistance rendered by an authorized employee of NECC & EIS. I seek this assistance

voluntarily and assume full responsibility for any damage or injury caused by utilizing this free

service.

2. I further release and discharge NECC & EIS, and their employees and agents for personal injury,

including death, loss or property damage arising out of jump starting of my motor vehicle, whether

caused by the fault of myself or NECC & EIS or other third parties.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I

FURTHER UNDERSTAND AND ACKNOWLEDGE THAT BY

SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER

CERTAIN LEGAL RIGHTS.

Print NAME: _________________________ Dated:____/_____/_____

Signature: ______________________

Address: ________________ JUMP START:

________________ Successful

________________ Failed

Location of service: ________________________

Vehicle Make __________________________ Vehicle Model: _______________________

Vehicle License Plate : _____________ License Plate State: ______________

Driver’s License or Student ID # _____________

PSSO Name: __________________________ PSSO Signature: __________________________