WAIVER AND RELEASE In consideration of the granting of my request to be permitted to come upon any building, vehicle, or other property

in the jurisdiction and control of Upper Merion Township, I do hereby waive all rights and claims, and release and exempt Upper Merion Township, its Police Department, its members, employees and agents from any and all claims for injuries, accidents, sickness, death and damages to person or property in what so ever nature sustained, whether to my person or to my property, which may arise by reason of my presence upon or in any building, vehicle or other property of Upper Merion Township or whether due to acts of God, accidents, or negligence of any third party or of the Upper Merion Township or any of its agents, members or employees, whether such members, agents or employees are acting in their official capacity or in an individual capacity or within or without the scope of their employment. Being at most a licensee, I undertake to assume the risk of all dangerous conditions in or about the property of the Upper Merion Township which dangerous conditions I realize can, may and do exist, and thereby waive notice of the existence of any such dangerous conditions. I also confirm that I have appropriate medical and disability insurance to cover any injuries or losses I may sustain while on Township property or in any Township building or vehicle. I represent that at the signing and sealing of this waiver and release, I am of lawful age and legally competent to execute the same and, before signing and sealing it, I have read its contents and execute it with full knowledge and understanding thereof. If not of legal age, my legal guardian has signed this waiver for me.

___________________________________________ APPLICANT SIGNATURE

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