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Lockout WavierWhitestown Fire Department

I hereby certify that I have been locked out of my vehicle and have requested the assistance of the Whitestown Fire Department to gain entry to that vehicle. I certify that:

  1. I am the owner of the vehicle described below
  2. I have presented my driver’s license to the WFD Firefighter for identification (or that I will do so, immediately upon gaining entrance to my vehicle if my driver’s license is locked in the vehicle)
  3. I will present the vehicle’s registration to the WFD Firefighter immediately upon gaining entrance to my vehicle to verify my ownership
  4. I am fully capable and competent to operate the vehicle described below

I agree that if I am unable to present this identification to the WFD Firefighter, the Firefighter may refuse to assist me in gaining entrance to my vehicle or, having gained entrance to my vehicle the Firefighter may relock my vehicle, leaving me in the same condition as I was prior to the Firefighter’s involvement.

I also understand, and agree, that the WFD Firefighter has the right to refuse entrance to my vehicle due to the possible release of the vehicle’s Airbag System, causing damage to the vehicle or possible injury to a person(s) trapped inside the vehicle. In an emergency situation the WFD Firefighter may use force, breaking a window to gain entry into the vehicle to rescue a victim. In a Non Emergency situation the WFD Firefighter has the right to refuse entrance and suggest that a Locksmith be called to gain entrance to my vehicle.

I hereby release, hold harmless and indemnify the Whitestown Fire Department, the Town of Whitestown, and any individual member of the Whitestown Fire Department, on my own behalf and on behalf of any other co-owners of the vehicle described above, from any damages, claims, or causes of action, whatsoever, including costs and attorney’s fees that may arise by reason of the assistance provided to me in gaining entrance to my vehicle and/or my subsequent operation of that vehicle.

Firefighter Information

Vehicle Owner Information


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