INFORMED CONSENT, WAVIER AND RELEASE AGREEMENT

FOR

THE LORAIN COUNTY OFFICE OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY

EMARSS AMATEUR RADIO VOLUNTEER PROGRAM

The undersigned, being at least eighteen years of age and a licensed amateur radio operator for a minimum of one (1) year, and in consideration for acceptance, approval and participation in the EMARSS Program, sponsored by The Lorain County Office of Emergency Management and Homeland Security, do hereby agree to this wavier and release.

I recognize that the EMARSS Program involves the use of my personally owned radio equipment, and may carry a risk of personal injury. I further recognize that there are natural and manmade hazards, environmental conditions, diseases, and other risks, which in combination with my actions can cause injury to me. I hereby agree to assume all risks which may be associated with or may result from my participation in the program, including, but not limited to, damage and/or loss of my radio equipment, damage and/or loss of/to my personal vehicle, transportation to and from volunteer sites, and other similar, related activities.

I recognize that EMARSS activities may involve physical and emotional discomfort. I state that I am free from any serious health problems that could prevent me from participating in any of the activities associated with this program. I further state that I am sufficiently physically fit to participate in the activities of this program. I accept the responsibility to refuse any work assignment that I feel would jeopardize my health, safety, believe to be illegal, or feel that I am not qualified to perform. I understand that in order for a licensed radio amateur to be able to respond to an emergency in Lorain County when communications assistance is requested, I must be a member of the EMARSS program. I further understand that at no time will I respond to any emergency scene without being requested to do so by the Lorain County Office of Emergency Management and Homeland Security.

I am aware that the EMARSS Program is not intended to be used during, or involve the operations of any SKYWARN program. I am further aware that amateur radio operators used solely to support operations required or requested at civic functions, the American Red Cross, or other organizations when the Lorain County Office of Emergency Management and Homeland Security is not involved are not part of this program and will not be covered under any of its allowances.

I recognize that if I am accepted for the program, I will be covered by the provisions of the “Worker’s Compensation Act” (ORC 4123.031 through 4123.037), during the time that I am performing approved volunteer activities. I specifically recognize that in accordance with this act, workers compensation and medical benefits shall be the exclusive remedy for any injury that I sustain in the course and scope of my approved participation in the program. In addition, I certify that I have medical insurance to cover the cost of any emergency or other medical care that I may receive for an illness or injury, that is outside of the program related medical coverage provided through workers compensation. I certify that if I do not have medical insurance, I will be personally responsible for the cost of any emergency or other medical care that is not covered under applicable workers compensation benefits. I agree to release The Lorain County Office of Emergency Management and Homeland Security, its departments, officers, employees, agents, and all sponsors and/or officials and staff from any said entity or person, their representatives, agents, affiliates, directors, servants, volunteers and employees from the cost of any medical care that I receive while participating in this program or as a result of it.

I further agree to release the Lorain County Office of Emergency Management and Homeland Security, it agencies, departments, officers, employees, agents, and all sponsors and/or officials and staff of any said entity or person, their representatives, agents, affiliates, directors, servants, volunteers and employees from any and all liability, claims, demands, actions, and causes of actions whatsoever for any loss claim, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of any and all activities associated with the aforementioned activities.

I further agree to hold harmless, and hereby release the above mentioned entities and persons from all liability, negligence, or breach of warranty associated with injuries or damages from any claim by me, my family, estate, heirs, or assigns from or in any way connected with the aforementioned activities.

Consent is expressly given, that in the event of injury, for any emergency medical aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary.

I HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THE FOREGOING LANGUAGE AND I SPECIFICALLY INTEND IT TO COVER ANY PARTICIPATION IN THE EMARSS PROGRAM SPONSORED BY THE LORAIN COUNTY OFFICE OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY.