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In consideration of granting this application, I herby for myself (my child/my ward), my (his/her) heirs, executors, and administrators, waive and release any and all rights and claims for damage I (my child/my ward) may have against the Rehoboth Beach Patrol and/or the City of Rehoboth Beach, their agents, representatives, assigns, for any and all injuries suffered by me (my child/my ward) while participating in the Surf-Lifeguard Pre-employment Test conducted for and by the Rehoboth Beach Patrol and the City of Rehoboth Beach.
Mail to: City of Rehoboth Beach, 229 Rehoboth Avenue, De 19971
Fax to: (302) 227-4643 Attention: Captain Buckson
Bring to: Pre-Employment Test
--------------------------NOT TO BE FILLED OUT BY APPLICANT-------------------------
Statement of Examining Physician (Optional)
This is to certify that I have reviewed the content of the Surf-Lifeguard Pre-employment Test and find the above applicant health enough to participate in said test at this time without danger to himself/herself.
Name ____________________________ M.D. License______________________