First Name:
Last Name:
Significant Other First Name:
Significant Other Last Name:
Address:
City:
State:
Zip:
Check one: ❏Area 1 ❏Area 3 (See definition of Areas in “About”)
Home Phone:
Cell Phone 1:
Cell Phone 2:
Email 1:
Email 2:
Other contact in case of emergency contact:
Phone:
Annual Membership Fee: $300 by check, or $300 by our Online Payment System, plus convenience fee for processing.
Check one: ❏New Member
❏ I’d like to add $_______as a general donation to help support the program.
❏ I’d like to sponsor a neighbor
Please send this form with payment to:
Schreiber Expanded Neighborhood Patrol (can make it to SENP)
Membership Coordinator
11816 Inwood Rd. #135
Dallas TX 75244-8011
Volunteer opportunities:
❏ I can host a block party meeting in my home to tell friends & neighbors about the program.
❏ I will walk my block and distribute ENP materials to promote the program.
❏ I am interested in helping with fundraising to support the program.
❏ Other help I can provide___________________________________________________
If you have any questions, please email [email protected].
TERMS and CONDITIONS
I am registering to be a member of the Schreiber Expanded Neighborhood Patrol (SENP), and I acknowledge, and I agree with the following Terms and Conditions:
A. The implementation of the SENP is one of many prevention tactics my neighbors have undertaken to deter crime and provide assistance to all residents of the Schreiber neighborhood community, defined to live within the borders of LBJ to the north, Forest Lane to the south, Inwood to the east and Midway to the west.
B. Notwithstanding the benefits of the SENP, it cannot and will not guarantee that participating members and/or residents of Schreiber neighborhood community, will not be a victim of a criminal incident or somehow be affected by criminal activity after the launch of this program.
C. No patrol service can prevent 100% of crime-related incidents or property damage from occurring in our neighborhood.
D. There is no guarantee that I will not be a victim of a criminal incident or somehow be affected by criminal activity after the launch of this program.
E. It is my intention to waive and release any claims that my I have might against SENP:
- As a result of the actions of the patrolling officers utilized by the SENP, regardless of any damages, loss, complaint, or claim that may arise as a result of having off-duty police officers patrol Schreiber neighborhood community.
- As a result of any third-party criminal activity at my home, or for which I or any member of my household, has property damages or stolen or suffers a personal injury including any bodily injury or death, in the Schreiber neighborhood community.
F. SENP does not guarantee any specific level of service to its members. SENP will provide service to all its members on a “best efforts” basis. In the event the service is interrupted or discontinued for any reason, including but not limited to insufficient membership, resident members and their households agree to discharge SENP and any claims I might have against SENP, including but not limited to breach of contract for cessation of service.
G. SENP does not employ police officers patrolling the Schreiber neighborhood community. The team of patrolling police officers are employees of the City of Dallas working in their capacity as Dallas Police Officers while patrolling our Neighborhood regardless of whether they are “on duty” or “off duty” in the eyes of the Dallas Police Department. There is no principal-agent relationship between the patrolling officers from the Dallas Police Department and SENP and SENP is not liable for their actions in any capacity. SENP does not exercise any control over the way a patrolling officer conducts himself in the line of duty. The patrolling officer’s actions and conduct are governed by the Dallas City Code. Therefore, I release, waive, and discharge any claims against SENP, as a result of the actions of the patrolling officers utilized by the SENP, regardless of any damages, loss, complaint, or claim that may arise as a result of having off duty police officers patrol Schreiber community neighborhood.
Accordingly, by signing up and registering as a participating member of the SENP, I hereby freely and voluntarily, with full understanding of the meaning of the following WAIVER AND RELEASE for the reliance and benefit of SENP.
WAIVER AND RELEASE
I acknowledge that I have read the foregoing Terms and Conditions and that I have registered to be a member of the Schreiber Expanded Neighborhood Patrol (SENP).
As a member of SENP, and in consideration of my acceptance of the Terms and Conditions, it is my intent to waive and release any claims that my I have might against SENP:
- As a result of the actions of the patrolling officers utilized by the SENP, regardless of any damages, loss, complaint, or claim that may arise as a result of having off-duty police officers patrol Schreiber community neighborhood.
- As a result of any third-party criminal activity at my home, or for which I or any member of my household has property damaged or stolen or suffers a personal injury including any bodily injury or death, in the Schreiber community neighborhood.
RELEASE: I HEREBY RELEASE, WAIVE, COVENANT NOT TO SUE, AND FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS, SCHREIBER EXPANDED NEIGHBORHOOD PATROL, A TEXAS NON-PROFIT ASSOCIATION AND ITS OFFICERS, DIRECTORS, VOLUNTEERS, AGENTS, SUCCESSORS AND ANYONE ACTING ON THEIR BEHALF (“SENP”) FROM ANY LIABILITY AS A RESULT OF ANY INCIDENTS (INCLUDING BUT NOT LIMITED TO “CRIMINAL” INCIDENTS) THAT OCCUR ON OR AFTER THE DATE OF THIS WAIVER, FOR ANY DAMAGE, INJURY, OR DEATH, INCLUDING ANY LOSS OR DAMAGE RESULTING FROM NEGLIGENCE, OR GROSS NEGLIGENCE, BY OR ON BEHALF OF “SENP.”
I UNDERSTAND THIS CONSTITUTES A WAIVER WHICH LIMITS MY RIGHTS, I ACKNOWLEDGE THAT IT IS MY INTENTION TO RELEASE SENP FROM ANY AND ALL LIABILITY, NOW OR IN THE FUTURE.
It is my intent that this Release shall be interpreted as broadly for the protection of SENP as permitted by the law of Texas, which is the exclusive law governing this Release. I irrevocably waive my right to trial by jury and consent to trial by judge. Without limiting my intent that this Release fully discharge SENP, in the event that any judge shall determine that any part of this Release is not effective to accomplish this purpose, I limit my right of recovery to actual damages only, waiving any right to indirect or consequential damages, the recovery of loss of income, attorneys’ fees, and punitive or exemplary damages.
I have read the entirety of this release carefully. I have signed this release freely and voluntarily, without inducement, assurance, or guarantee, and intend my signature below to serve as confirmation of my complete and unconditional acceptance and Agreement to be bound by all terms and conditions of this release.
I acknowledge that I am waiving negligence claims, gross negligence claims, personal injury claims, and mental anguish claims.
Full Address:________________________________________________________________
Signature: _____________________________________ Dated: _________________
Print Name: _________________________________________________________________
Signature: _____________________________________ Dated: _________________
Print Name: ____________________________________________________________
For those paying by check, print out this entire form and mail with check to address noted above.