North Plainfield Police Department

Appendix A

North Plainfield Police Department

Gym Sign in Sheet

Appendix B

North Plainfield Police Department

Physical Fitness Facility Agreement

As a condition for the use of the Physical Fitness Facility that is maintained by the Borough of North Plainfield,an employee of the North Plainfield Police Department, attest to the following:

Name: ______ID #: ______

I have consulted with my personal physician(s) concerning my intention to use the borough’s physical fitness facility that is maintained by the North Plainfield Police and Fire Departments. I have advised said physician(s) that the equipment in the facility includes (by way of example only) treadmills, elliptical cross trainers, exercise bikes, free weights, plate loaded equipment and body building machines.My personal physicians(s) has determined that I am physically, mentally and emotionally capable of utilizing said equipment with no danger of personal injury to myself or others.

I have read, received a copy of, and understand the provisions of G.O. 10-01, which governs police employee use of the physical fitness facility. I understand it is my responsibility to make arrangements with the Patrol Commander for instruction in the proper use of any gym equipment, with which I am not familiar prior to using the equipment.

In consideration for being allowed to use the North Plainfield Police Department Physical Fitness Facility and participate in the fitness training, I hereby release the Borough of North Plainfield, and it's Officials, Directors, Members, Agents, Officers, Successors, and Assigns from any and all claims, demands, actions, or causes of action whatsoever, and from any and all liability for any loss, property damage or personal injury of any kind, nature, or description, that may arise or be sustained by me during or related to my use of the gym and/or participation in the fitness training. I understand that my use of the gym is voluntary and not required as part of my job.

This release shall be binding upon my Heirs, Administrators, Executors, and Assigns. However, there shall be no waiver for medical or any other insurance coverage which I am entitled to as an employee.

I represent that I have read and understand this release of liability and acknowledge that this release is being relied on by the Borough of North Plainfield in permitting me to use the borough’s physical fitness facility and a copy will be maintained in my personnel file. I understand that at any time I may review this release by requesting a copy through the Chief’s Office.

Officer / Employee Name (Print)______

Officer / Employee Name (Sign)______Date ______