_______________________________________________ Fire Department

Smoke Alarm Liability Release Agreement

 

DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ AND
UNDERSTOOD ITS MEANING AND INTENTIONS.

 

I have received a smoke alarm from the City/County of ____________________and agree to allow the City/County of ____________________ Fire Department to install the smoke alarm in my home. I understand that the City/County ____________________ Fire Department is installing a alarm that is being provided by the City/County of ____________________, for residents only. The installation and alarm are provided at no cost to me or any member of my household.

For this reason, I agree and understand that the alarm and its installation are WITHOUT warranty of any kind (merchantability of fitness) from the program and that the only warranties that may exist are the limited warranties (if any) provided by the smoke alarm manufacturer or distributor.

I agree that I will NOT hold or attempt to hold the City/County of __________________ liable or responsible and hereby release “harm from” any and all liability or claims that might be made for any injury, death or property damage that might occur should the smoke alarm fail or malfunction for any reason, including defects or errors in design, manufacture or installation.

 

I agree to and accept the above conditions.

Date _____/_____/_____

 

Recipient Name ____________________________________________

 

Recipient Signature _________________________________________

 

TO BE COMPLETED ONLY IF RECIPIENT IS UNABLE TO READ
The foregoing was read by me at recipient’s request.

 

Witnessed by _______________________________________________

 

Fire Department Rep. _________________________________________

 

Phone Number ______________________________________________