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Third Rider Program (Hold Harmless Agreement)

  1. Hold Harmless Agreement
    THE UNDERSIGNED HEREBY requests permission from the City of Las Cruces and Las Cruces Fire Department (LCFD) to participate with LCFD in the following program/activity:
  2. Check One*
    recognizes that there are many risks of injury to the undersigned, both from the activities of LCFD as well as from the activities of third parties. In order to induce the City and LCFD to grant such permission, the undersigned does hereby agree to hold harmless and indemnify the City and LCFD from any and all claims, injuries or damages which the undersigned may sustain while participating in such fire and emergency activity and does waive any right of which the undersigned might have to pursue a claim against the City or LCFD for any such claims, injuries or damages. IF OVER 18 YEARS OF AGE, APPLICANT MUST SHOW PROOF OF AGE.
  4. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  6. This field is not part of the form submission.