RELEASE AND INDEMNIFICATION AGREEMENT

I understand that the following agreements are a prerequisite to my participation in the Community Emergency Response Team ("CERT") Program sponsored by the Harris County Citizen Corps ("HCCC") and, further, I understand that these agreements are made in consideration of HCCC allowing me to participate in the CERT program.

My participation in the CERT program is voluntary. I understand HCCC is under no obligation to use my services in the CERT program and may terminate my participation at any time, with or without cause, without notice to me. I further understand that I will receive no compensation, wages, insurance coverage, or any other employment benefit for 
my participation in the CERT program. While participating in the CERT program, I will follow any rules or requirements set forth by HCCC. I understand that HCCC has sole discretion to direct my activities and may change those assigned activities without notice to me.

CONFIDENTIALITY STATEMENT. I hereby acknowledge my responsibility and agreement under applicable Federal and Texas law and this document, to keep confidential any information regarding health information of any person, living or dead, obtained by or revealed to me in any manner while participating in the CERT program, except as required by law or authorized by HCCC.

INDEMNITY AND RELEASE: I AGREE TO INDEMNIFY AND HOLD THE HARRIS COUNTY CITIZEN CORPS AND HARRIS COUNTY, THE CITY OF HOUSTON, EACH AND EVERY MUNICIPALITY AND GOVERNMENTAL UNIT WITHIN HARRIS COUNTY, AND THEIR OFFICERS, AGENTS, AND EMPLOYEES HARMLESS FROM ALL CLAIMS OF ANY CHARACTER, TYPE, OR DESCRIPTION, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, 
GROSS NEGLIGENCE, AND/OR WILLFUL AND MALICOUS CONDUCT ARISING OUT OF OR IN ANY WAY CONNECTED WITH MY PARTICIPATION IN THE COMMUNITY EMERGENCY RESPONSE TEAM PROGRAM. I ALSO RELEASE AND HOLD HCCC AND HARRIS COUNTY, THE CITY OF HOUSTON, EACH AND EVERY MUNICIPALITY AND GOVERNMENTAL UNIT WITHIN HARRIS COUNTY, AND THEIR OFFICERS, AGENTS, AND EMPLOYEES HARMLESS FROM ALL CLAIMS OF ANY CHARACTER, TYPE, OR DESCRIPTION, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE AND/OR GROSS NEGLIGENCE, WHETHER OR NOT SUCH NEGLIGENCE IS CAUSED BY AN OFFICER, EMPLOYEE, OR VOLUNTEER IN THE CERT PROGRAM, OR HCCC, OR HARRIS COUNTY, OR THE CITY OF HOUSTON, OR ANY MUNICIPALITY OR GOVERNMENTAL UNIT WITHIN HARRIS COUNTY, RESULTING IN ANY INJURY TO MYSELF OR MY PROPERTY BECAUSE OF MY PARTICIPATION IN THE CERT PROGRAM. THIS INDEMNITY AND RELEASE IS BINDING ON ME, MY FAMILY, ESTATE, HEIRS, AND ASSIGNS.

Signature of Participant	
Date signed
Name Printed
Address
Licensed as:	       
License   #
The State of Texas 
County of Harris 
This instrument was acknowledged before me on___________________by	
NOTARY PUBLIC in and for the State of Texas
My commission expires: