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This form must be filled out and signed by the applicant, (participants under the age of 18 years must have a parent or legal guardian sign also) before beginning a driving program. Name ________________________________________________________ Home Address _________________________________________________ City _________________________________________ State _____ Zip____ Phone _____________________________ Date of Birth_________________ The undersigned participant and his or her parent or legal guardian, if the participant is under the age of 18 years, does herby execute this release, waiver and indemnification for themselves and their heirs, successors, representatives and assigns; and hereby agree(s) and represent(s) as follows: To release the South Dakota Safety Council, its members, employees, agents, and reprehensive form any and all liability, loss, damage, costs, claims and/or causes of action, including but not limited to all bodily injuries and property damage arising out of participation in any driving program. The undersigned further agree(s) to indemnify the South Dakota Safety Council, its employees, members, agents, and representatives and hold them harmless for any liability, loss damage, cost, claim, judgment or settlement which may be brought or entered against them as a result of the undersigned's participation in any driving program. This indemnification shall include attorney's fees incurred in negotiating any settlement. It is understood and agreed that the undersigned shall have the opportunity to consent to any such settlement, provided, however that such consent shall not be unreasonably withheld
Additional Pages Drivers Ed Registration Form |
Contact the South Dakota Safety Council at sdsc@southdakotasafetycouncil.org or phone 605-361-7785/800-952-5539.