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Wheaton Car Seat Safety Program

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  2. WHEATON POLICE DEPARTMENT WAIVER AND RELEASE AGREEMENT FOR CAR SEAT SAFETY PROGRAM

    Please read carefully and be aware that in signing this agreement and participating in the WHEATON POLICE DEPARTMENT CAR SEAT SAFETY PROGRAM, you will be expressly waiving and releasing all claims for injuries, damages, or loss that you might sustain as a result of participating in any and all of the activities connected and associated with the CAR SEAT SAFETY PROGRAM.

    SECTION I: PERSONAL INFORMATION

  17. Please bring the Child Safety Seat manual (if you have one) with you to your appointment.

  19. Vehicle #1
  25. Vehicle #2

  35. SECTION II: AGREEMENT

    In consideration of the opportunity to participate in the CAR SEAT SAFETY PROGRAM, I hereby agree to the following:

    #1. I understand and agree that the sole purpose of the CAR SEAT CHECK PROGRAM is to help reduce the incidence of improper installation and use of car seats, booster seats, and seat belts. I further understand that this inspection and demonstration is being provided as a free educational service to me in the interest of public safety. I realize that the CAR SEAT CHECK PROGRAM sponsors and certified child seat technicians inspecting the seat(s) cannot fully evaluate the quality, safety, or condition of my car seat, booster seat, or any component (vehicle seats/safety belts) of my vehicle now or in the future. I understand that on occasion the certified child seat technicians must use a great deal of force to properly secure the car seat or booster seat into the vehicle. Furthermore, I understand the actions taken in this program will not guarantee a child’s safety in a motor vehicle crash. I recognize it is important to read and follow the instruction manuals for both the vehicle and the child restraint seat. I understand that to have the full protective benefit of the child safety seat the infant and/or child must at all times be properly secured to the child safety seat and the child safety seat must at all times be properly secured to the vehicle in accordance with the vehicle and child safety seat manufacturer’s instructions, and in conformance with Illinois law.

  39. #2. I hereby forever release and waive my right to bring suit against the City of Wheaton, its corporate authorities, elected and appointed officials, officers, boards, commissions, legal counsel, agents, employees, volunteers, representatives, or contractors (the “Releasees”) from any claim, demand, loss, liability, damages, and attorney fees and costs (hereinafter “Claims”) whatsoever for: (a) any and all damage(s) caused to my vehicle and/or contents therein while installing the child safety seat(s); and (b) personal injuries, death, or disease (hereinafter (a) and (b) are collectively referred to as “Damages”) arising from, related to, or resulting from a vehicle collision or other vehicular accident, and/or from my participation in the CAR SEAT SAFETY PROGRAM, and/or from the Releasees’ inspection and/or installation of any car seat brought for my participation in the CAR SEAT SAFETY PROGRAM, including, but not limited to those Claims caused by the negligent acts or omissions, or willful and wanton misconduct, by omission or commission, foreseen or unforeseen, of any or all of the Releasees. If my child(ren) or any minor under my legal custody or care brings any Claim(s) for Damages resulting from my participation in the CAR SEAT SAFETY PROGRAM, and/or from the Releasees’ inspection and/or installation of any car seat brought for my participation in the CAR SEAT SAFETY PROGRAM, I agree to defend, indemnify, and hold harmless the Releasees from any and all such Claims.

  43. #3. I understand and agree that the law of the State of Illinois will apply to this Waiver and Release Agreement.

  47. #4. I agree that if any portion of this Waiver and Release Agreement is held to be invalid, the balance notwithstanding shall continue in full force and effect.

  51. #5. I agree that if any portion of this Waiver and Release Agreement is held to be invalid, the balance notwithstanding shall continue in full force and effect.

  55. #6. I, the undersigned, certify that I am at least Eighteen (18) years of age.

  59. I, THE UNDERSIGNED, HAVE READ THIS WAIVER AND RELEASE AGREEMENT FULLY AND I AM AWARE THAT BY SIGNING BELOW, AND BY PARTICIPATING IN THE WHEATON POLICE DEPARTMENT CAR SEAT CHECK PROGRAM, I AM RELINQUISHING SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO FINANCIAL RECOVERY FOR INJURY, INCLUDING INJURY TO MY MINOR CHILD(REN) OR ANY MINORS UNDER MY LEGAL CUSTODY OR CARE, WHETHER THE INJURY RESULTS FROM THE INHERENT RISKS OF THE ACTIVITY OR FROM THE ORDINARY NEGLIGENCE OR WILLFUL AND WANTON MISCONDUCT OF THE RELEASEES. 

    I, THE UNDERSIGNED, AM VOLUNTARILY PARTICIPATING IN THE WHEATON POLICE DEPARTMENT CAR SEAT CHECK PROGRAM AND I AM EXECUTING THIS AGREEMENT OF MY OWN FREE WILL AND WITHOUT ANY RESERVATION WHATSOEVER, WITH THE FULL INTENT OF WAIVING AND RELEASING THE RELEASEES FOR INJURY OR LOSS.

    Note: A representative from the Wheaton Police Department will contact you to confirm your appointment.

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