GWINNETT COUNTY SHERIFFS DEPARTMENT PRETRIAL HOUSE ARREST PROGRAM WAIVER, RELEASE OF LIABILITY & INDEMNIFICATION Defendant:________________________________________________ I hereby request permission to participate in the Pretrial Arrest Program. In consideration ofmy participation in the Pretrial House Arrest Program, this program, and other good and valuableconsideration, the receipt of which is hereby acknowledged, on behalf of myself, my heirs, executors,administrators, agents and assigns, I do hereby release and discharge the Board of Commissionersof Gwinnett County, the Sheriff of Gwinnett County, and Gwinnett County, and all their respectiveemployees, agents and assigns from all claims, demands, actions and causes of action, of any kind,arising out of my participation in the Pretrial House Arrest Program. This release and indemnity shallsurvive my participation in this program. In executing this unconditional waiver, release of liability and indemnification, I state that mydecision to participate in the Pretrial Arrest Program is made freely, voluntarily and knowingly. ThePretrial House Arrest Program has been explained to me to my complete satisfaction. I know andacknowledge the risks involved in this program. I assume all risks connected with my participation inthe Pretrial House Arrest Program. I agree to indemnify and hold harmless, all members of the Boardof Commissioners, the Sheriff of Gwinnett County, Gwinnett County, and all their respectiveemployees, agents and assigns from such all claims, demands, actions and causes of actionconnected with my participation in this program, including, but not limited to, principal, interest, courtcosts and reasonable attorneys fees. As I will be living apart from the Gwinnett County Detention Center during the period of PretrialHouse Arrest, I hereby assume all responsibilities and shall bear all financial costs connected with myown living expenses, including, but not limited to, food, clothing, shelter, transportation, health careexpenses and all other personal expenses. I release from liability the Gwinnett County Board ofCommissioners, the Sheriff of Gwinnett County, and all of their employees, agents and assigns, fromall costs, in whole or in part, connected with any expenses incurred of any kind incurred during myparticipation in the Pretrial House Arrest Program. I hereby, acknowledge and represent that I have: a. read this document in its entirety and fully understand each and every term and provision hereof; b. signed this document freely, voluntarily and knowingly, without the interference, force, duress or coercion of anyone. Date:_________________________ ______________________________________ Defendants SignatureWitness: ___________________________ Print Name:_________________________ W:\Magforms\MAG 95-05\Release & Waiver (June 02)