Accident WaiverWhitestown Fire Department
I have been involved in a minor incident and I have no injuries and do not desire further evaluation. I understand that I have not been treated or cared for by a physician. I understand that serious injuries and/or illness may have occurred even though I feel fine. I do not wish to be transported to the hospital or receive any medical care at this time. I understand that if any problem develops that I should seek immediate medical attention and may call 911 at any time that I feel an emergency exists.
I am releasing Whitestown Fire Department Paramedics/EMT’s from any and all liability regarding my physical condition at this time.
I understand that I am assuming full responsibility for my physical condition in regard to this incident.