VERSHAWN YOUNG EXTERNSHIP-EDUCATION-AGREEMENT.DOCX

EXTERNSHIP AGREEMENT
This Agreement shall be effective [insert date] (the "Effective Date"). The parties to this
Agreement are [Mitchell Hamline School of Law] ("School") and Maricopa County ("County"),
a political subdivision of the State of Arizona, administered by its Maricopa County Office of the
Legal Defender ("Facility").
WHEREAS, School wants to provide clinical experiences for the School's students
("Students") as part of their overall education; and
WHEREAS, County, through its Facility, is willing to provide clinical training to
School's Students; and
WHEREAS, it is to the benefit of both School and Facility to cooperate in the
educational preparation of Students, so as to promote excellence in legal representation, to
ensure professional competence, and to provide maximum utilization of community resources,
NOW, THEREFORE, IT IS MUTUALLY AGREED that School may place selected
Students in the Facility for such clinical experiences (the "Program") according to the following
terms and conditions:
1. Program Description and Mutual Responsibilities of the Parties.
1.1 School shall retain full control and responsibility for the academic education of
the Students. Any educational goals and objectives for a rotation must be provided by School to
Facility prior to the start of the rotation and will be subject to Facility's acceptance and approval.
See Extemship Education Agreement and Specific Expectations attached as Exhibit A. In the
event of a conflict between this Agreement and the terms of Exhibit A, this Agreement will
control.
1.2 The number of Students accepted into the Program and schedule of assignments
shall be arranged in advance by mutual agreement between Facility and School. In the event it
becomes necessary to cancel a reserved space or change a student assignment, School will
immediately notify Facility.
1.3 School and Facility shall each designate a coordinator who shall be reasonably
available for consultation with the other respective coordinator concerning each Student's
qualifications, clinical experience performance, and the curriculum of the Program.
1.4 School agrees to designate for participation in the Program only Students who
have completed the necessary training, appropriate prerequisites and didactic work for the
Program and who are in good standing. All Students shall be subject to Facility's standards of
Program admission and participation. School shall ensure that the Student's execute a Student
Acknowledgement reflecting the same prior to placement. See Extemship Student
Acknowledgement, attached as Exhibit B.

1.5 Facility assumes full responsibility for the representation of its clients.
1.6 As part of their educational experience, Students may be asked to review client
records to help support Facility's quality assurance projects without necessarily having the client
records de-identified.
1.7 At all times during the term of this Agreement, all services shall be performed in
accordance with all applicable standards established by law or ordinance, or established by the
rules and regulations of any federal, state, or local agency, department, commission, association,
or other pertinent governing, accrediting, or advisory body having the authority to set standards
for offices maintained by health care providers.
1.8 Facility and School agree to cooperate with each other and share information, to
the extent allowed by law, in the event of any investigation, audit, peer review matter,
disciplinary action or third-party liability claim arising out of the Program or any services
provided under this Agreement or any adverse event that may result in liability to the other party
in connection with their performance under this Agreement.
2. School's Responsibilities.
2.1 School shall advise all Students that they may be required to pass a physical
examination and drug screening when appropriate for the specific extemship; will be required to
have up-to-date immunizations including a hepatitis B series; and may be required to complete a
criminal background check by the Facility (or its agent). School or Student will be responsible
for the cost of screenings not performed by Facility (including physical examination and drug
test, if applicable). School shall provide Facility with documentation upon request establishing
that each Student has undergone the appropriate screening and any necessary documentation to
perform a background check, if required. Facility (or its agent) shall review any such
documentation to determine if Student is eligible for the extemship.
2.2 School shall maintain all personnel and academic records relating to Students.
2.3 School shall require all Students and any other personnel furnished by School to
comply with all applicable rules, regulations, policies and procedures of the Facility and to
maintain confidentiality of client information in accordance with applicable law, as well as the
confidentiality of records and operations of the Facility. Students shall be required to
acknowledge these responsibilities at the start of the Program on a form prepared by Facility and
to grant School and Facility permission to share educational records necessary to the Program,
including written evaluations from Site Supervisor to School.
2.4 School shall reimburse Facility for any breakage or damage to equipment or
supplies, provided Facility provides evidence that such breakage or damage was caused by a
Student or School faculty member.
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3. Facility's Responsibilities.
3.1 Facility will determine the locations and assignments for each Student in the
Program and notify School of available assignments.
3.2 Facility agrees (i) to provide direct supervision of Students and practical
instruction while on the assigned premises for the Program at Facility locations by qualified
supervisors who are on staff at the Facility ("Site Supervisor"); and (ii) to complete written
evaluations on each Student on forms provided by School.
3.3 At all times during the term of this Agreement and any renewal or extension
hereof, Facility shall, at its own expense, comply with applicable state and federal laws and
regulations including but not limited to OSHA standards with respect to each of School's
employees, agents and Students present at the Facility.
3.4 With respect to any quasi-professional services provided by Students under this
Agreement, Facility shall notify School and its Program Director(s) as soon as possible of the
initiation of any investigation of a Student or School faculty member.
4. Family Educational Rights and Privacy Act ("FERPA"). Facility and School agree to
abide by the limitations set forth under FERPA and regulations at 34 CFR 99.33 regarding the
protection of educational data. Both parties acknowledge that this Agreement allows access to
educational data, and agree to hold that information in strict confidence and not to use or disclose
educational data received from or on behalf of either institution except as permitted or required
by this Agreement, as otherwise required or allowed by law, or as authorized in writing by
Student.
5. Policies and Procedure Governing Students. In addition to any policies and
procedures of School that govern Students' conduct, Students shall be subject to and follow
Facility's policies and procedures, including standard precautions, while participating in the
Program. Notwithstanding any provision to the contrary, Students shall not be entitled to any
defense or indemnity by the County, or to any stipends, benefits, terms or rights that are afforded
County employees, including workers' compensation, health insurance or medical benefits,
pension, retirement, or vacation or sick pay.
6. Termination of Student Experience. Facility may terminate the participation of a
Student in the Program if the Student's work, conduct or health might, in Facility's sole
discretion, have detrimental effect on its clients, staff, or operations. Facility shall not be
arbitrary or discriminatory in the exercise of this right.
7. Student Health Insurance and Emergency Medical Care. Students shall be
responsible for maintaining health insurance throughout the entire term of their participation in
the Program. Students may be furnished emergency medical care and treatment, if needed, while
on duty at Facility with the associated expense to be the responsibility of the Student.
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8. Indemnification. To the fullest extent permitted by law, each party shall defend,
indemnify, and hold harmless the other party, its agents, representatives, officers, directors,
officials, and employees for, from and against all claims, damages, losses and expenses,
including, but not limited to, attorneys' fees, court costs, expert witness fees, and the cost of
appellate proceedings, relating to, arising out of, or alleged to have resulted from the negligent
acts, errors, omissions or mistakes relating to the performance of this Agreement. Each party's
duty to defend, indemnify and hold harmless the other party, its agents, representatives, officers,
directors, officials, and employees shall arise in connection with any claim, damage, loss or
expense that is attributable to bodily injury, sickness, disease, death, or injury to, impairment, or
destruction of property, including loss of use resulting therefrom, caused by any negligent acts,
errors, omissions or mistakes in the party's performance of this Agreement including any person
for whose acts, errors, omissions or mistakes a party may be legally liable.
The amount and type of insurance coverage requirements set forth in Section 10 below
will in no way be construed as limiting the scope of the indemnity in this Section. Further, the
scope of indemnification does not extend to the sole negligence of either party.
9. Insurance. Both parties shall maintain insurance or funded self-insurance as follows:
(i) commercial general liability insurance coverage with minimum limits of $2,000,000 per
occurrence and $4,000,000 annual aggregate; (ii) professional liability insurance coverage with
minimum limits of $1,000,000 per occurrence and $3,000,000 annual aggregate; and
(iii) workers' compensation insurance to cover obligations imposed by federal and state statutes
applicable to the respective party's employees engaged in the Program. Upon written request, a
party shall provide to the other party a certificate of insurance evidencing such insurance
coverage. Each party shall endeavor to provide thirty (30) calendar days prior written notice to
the other party of any modification or termination of required insurance.
10. Relationship of the Parties. Each party is a separate and independent institution, and
this Agreement shall not be deemed to create a relationship of agency, employment, or
partnership between or among them. Each party understands and agrees that this Agreement
establishes a bona fide training relationship and that the agents, Students, and employees of each
respective party are not employees or agents of the other party.
11. Term. This Agreement is for a term of one (1) year and will automatically renew for
subsequent one-year terms for a total of five (5) years, unless terminated as described in Section
12 below.
12. Termination. This Agreement may be terminated by either party upon thirty (30) days
prior written notice to the other party; provided, however, Students participating in an ongoing
clinical experience at the time shall be given the opportunity to complete their participation. In
such event, all applicable provisions of this Agreement shall remain in force during the extension
period from the effective date of termination, until the end of the academic term in which the
Students are enrolled.
13. Notices. Communications regarding the Program shall go through the parties' designated
coordinators. Any legal notice that is required or permitted to be given by a party to the other
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shall be deemed to have been sufficiently given if personally delivered or deposited in the U.S.
Mail in a properly stamped envelope, addressed to:
For School For County
Ms. Ann Juergens Maricopa County Board of Supervisors
Professor of Law Attn: Clerk of the Board
Mitchell Hamline School of Law 301 West Jefferson Street, 10th Floor
875 Summit Ave. Phoenix, Arizona 85003
St. Paul, MN 55105-3076
Copy to Facility:
Maricopa County Office of the Legal
Defender
222 N. Central Ave., Ste. 8100
Phoenix, AZ 85004
15. Amendments. This Agreement may be amended from time to time only by written
agreement of the parties.
16. Use of Names. No party shall use the name, trademark, logo, or likeness of another
party, or another party's employee or agent in any publicity or advertising material without such
other party's express prior written consent; however, the existence and scope of the Program
available via this Agreement may be made known to Students as a means of assistance in
completing their training requirements.
17. Assignment. Neither party shall assign all nor part of this Agreement without the prior
written consent of the other party which consent shall not be unreasonably withheld; provided,
however, that this Agreement may be assigned by either party without consent of the other to an
affiliate or to any third party who succeeds to substantially all of its businesses or assets. In the
event of a valid assignment, this Agreement will inure to the benefit of and be binding upon each
party and its respective successors and permitted assigns.
18. Governing Law and Venue. This Agreement shall be construed in accordance with the
laws of the State of Arizona. Exclusive venue and jurisdiction for any actions or proceedings
related to or stemming from this Agreement shall be in the state or federal courts sitting in
Phoenix, Arizona.
19. Conflict of Interest. The County's participation in this Agreement is subject to A.R.S. §
38-511, which provides that this Agreement may be cancelled if any person significantly
involved in initiating, negotiating, securing, drafting or creating this Agreement on behalf of the
County is, at any time while this Agreement, or any extension thereof, is in effect, an employee
or agent of the other party to this Agreement in any capacity or consultant of the other party with
respect to the subject matter of this Agreement.
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20. Enforceability and Waiver. The invalidity or unenforceability of any term or provision
of this Agreement shall in no way affect the validity or enforceability of any other term or
provision. The waiver by a party of a breach of any provision of this Agreement shall not
operate as or be construed as a waiver of any subsequent breach thereof.
21. Non-exclusive Agreement. Each party may enter into similar agreements with other
training institutions, provided that such agreements do not materially interfere with the ability of
each party to carry out its obligations hereunder.
22. Compliance with Laws. Each party shall, to the extent such provisions apply, comply
with all federal and state laws, ordinances, Executive Orders, rules, regulations, standards, and
codes whether or not specifically referenced herein, including, but not limited to: Title VI and
VII of the Federal Civil Rights Act; the Federal Rehabilitation Act; the Age Discrimination in
Employment Act; the Americans With Disabilities Act, as amended; the Immigration Reform
and Control Act of 1986 (IRCA); and Arizona Executive Order 2009-9, which mandates that all
persons shall have equal access to employment opportunities. Unless exempted under Federal
law, the parties shall not discriminate against any employee or applicant for employment because
of race, age, disability, color, religion, sex or national origin.
23. Counterparts. This Agreement may be executed in multiple counterparts, each of which
shall be deemed an original, and all of which together shall constitute one and the same
instrument.
24. Entire Agreement. This Agreement represents the entire agreement between the parties
with respect to the subject matter hereof, and supersedes all prior agreements and
representations.
25. Authority. The persons signing this Agreement warrant that they have full authority to
do so and that their signatures shall bind the parties for which they sign.
[Signature Page to Follow]
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective
dates written below.
MITCHELL HAMLINE SCHOOL OF LAW MARICOPA COUNTY
By: By:
Name: Name:
Title: Title: Chairman, Board of Supervisors
Date: Date:
ATTESTED TO:
By:
Name:
Title: Clerk of the Board
Date:
APPROVED AS TO FORM:
By:
Name:
Title: Deputy County Attorney
Date:
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EXHIBIT A

11/16/16
MITCHELL HAMLINE SCHOOL OF LAW (MHSL)
EXTERNSHIP EDUCATION AGREEMENT
THIS A GREEMENT MUST BE TYPED.
Check the course you are registering for:
0 Independent Externship (Course Number 4355)
0 Independent Judicial Externship (Course Number 4900)
Externship Course
Course Name: Externship: General
Course Number: 4354 H
Student Name: Vershawn Ashanti Young
ID #: 207416
Address: 88 Valley Ridge Crescent, Waterloo, ON, CA N2T 1X2
Phone: 519-575-1815
Email address (default is MHSL address):
Semester: Fall 0 Spring Summer 0 Year 20 17
Professional Responsibility course completed? Yes Eg Taking it concurrently 0 No0
Credits: One 0 Two 0 Three 1:0 Four 0
I understand that for each credit received, the Student must log 45 hours, including time working at
the placement site and time spent working with the Faculty Supervisor. Forty-five hours requires an
average of 3 hours per week for 15 weeks.
Field Placement Organization/Court:MaricopaCounty Office of the Legal
Defender
Website: http://wwvv.maricopa.gov/legaldefender/
Address: 222 North Central Avenue, Suite 8100, Phoenix, AZ 85004
Name of Field Supervisor (must have JD): Jeremy Bogart
Title: Legal Defender
Phone: 602-506-8855
Email: Jeremy.bogart@old.maricopa.gov
Name & Title of Faculty Supervisor:' Ann Juergens, Professor of Law
El Check here if placement organization is a 501(e)(3) organization or government agency.
Your hours will qualify for public service recognition. Any hours worked over your credit
hours qualify for MJF volunteer public service hours. Please log in your MJF hours.
This box is for Jean Backes's use only Faculty:
In the context of an externship course, the term "Faculty Supervisor" refers to the course instructor throughout this
agreement.

EXTERNSHIP EDUCATION AGREEMENT
PAGE 2
REQUIREMENTS FOR ALL EXTERNSHIPS
All externships consist of two components: (a) a work experience under the supervision of the
Site Supervisor; and (b) an academic component under the supervision of the Faculty Supervisor.
This section of the Agreement sets out the minimum requirements expected of the Site Supervisor,
Faculty Supervisor, and Student in order for MHSL to grant academic credit for an externship.
Each must complete the section that relates to his or her role.
Site Supervisor's Agreement: Thank you for your support, supervision, and mentoring of a
law student extern. Please initial each requirement to indicate your agreement (typed is fine).
As Site Supervisor, I agree to the following:
JB Supervision: I have the authority, ability, and resources to ensure that the Student is
supervised by a licensed attorney or other qualified individual who will (1) help the
Student develop and meet learning goals for the extemship, and (2) actively direct,
monitor, and mentor him/her throughout the semester.
JB Field Activities: The Student will be engaged in (1) a substantial lawyering
experience that (2) exposes the Student to a variety of lawyering skills and tasks (3)
in furtherance of the Student's learning goals and (4) includes multiple opportunities
for performance, feedback, and self-evaluation. Assignments may include (without
limitation) drafting contracts, briefs, pleadings or other legal documents; researching
and writing legal memoranda; interviewing clients, witnesses, or other persons with
relevant information; attending negotiations or mediations; and observing or
participating in meetings, depositions, or court proceedings. Administrative work
will be kept to a minimum.
JB Communication & Feedback: I will keep the Student informed about office
practices and assignment requirements and deadlines. I will be available to meet with
the Student to provide instruction, support, and feedback on assignments. The
Student will be provided specific, individualized, and timely feedback on his/her
work.
JB Participation in Evaluation: T will cooperate with MHSL in evaluating the quality
of the Student's extemship experience and the Student's performance, including
meeting regularly with the Faculty Supervisor or Externship Director by phone or in
person, reviewing any student self-assessments, and completing evaluations.
JIB Legal Compliance: My organization is responsible for ensuring that our labor and
employment practices are in compliance with applicable state, local, and federal
laws, including any student practice requirements.
JIB Assistance and Support: I will contact the Faculty Supervisor or Extemship
Director with any questions, concerns, or requests for additional support.

EXTERNSHIP EDUCATION AGREEMENT
PAGE 3
Student's Agreement: Please initial each requirement to indicate your agreement (typed is
fine).
As a student extern, I agree to the following:
Vav Professionalism: I agree to (1) follow directions, seek clarification and advice in a
timely fashion, and comport myself with professionalism and integrity; (2) abide by
the field placement site's confidentiality and privilege rules and policies, including in
any writing or discussions with the Faculty Supervisor; and (3) abide by the agreed-
upon schedule, including showing up on time, providing sufficient notice for any
absences, and contacting the Site Supervisor immediately if I am ill or have an
emergency.
Vay Learning Goals: I understand the purpose of the externship is to learn while
performing legal work under the supervision of an attorney, judge or other qualified
individual. I will create learning goals for the semester and discuss these with my
Site Supervisor and Faculty Supervisor. I will ask questions, become involved inthe
work of the office, and devote myself to use the time at the placement to learn
everything I can.
Vav Self-Evaluation: I will strive to assess my performance on each assignment I
complete. In so doing, I will consider what I did effectively and areas for
improvement. Where possible and appropriate, I will discuss my self-assessment with
my Faculty and Site Supervisors. I will be open to feedback from my supervisors and
will consider how it can be related and applied specifically to my future work.
Vav Academic Component: I will meet with the Faculty Supervisor to reflect on the
observations, experiences, ethical considerations, and other issues that arise during
my extemship. I agree to complete all required readings, evaluations, and other
assignments required by the Faculty Supervisor. In so doing, I will be mindful of my
confidentiality obligations. If requested to do so, I will participate in mid-semester
evaluation discussions with the Site Supervisor and Field Supervisor.
Vav ;Timekeeping: I will keep detailed time records using MHSL' s online timekeeping
system.
Vav Assistance and Support: If any problems arise during my extemship or if Ihave any
concerns, I will immediately contact my Faculty Supervisor.
Faculty Supervisor's Agreement: Please initial each paragraph to indicate your agreement
(typed is fine).
As Faculty Supervisor, I agree to the following:
AJ Academic Requirements: I will establish requirements (such as meetings, readings,
reflective papers or journals, or other assignments) designed to support and enrich the
Student's experience in his/her placement, including through self-evaluation and
reflection.

EXTERNSHIP EDUCATION AGREEMENT
PAGE 4
AJ Site Evaluation: I will remain in regular contact, including possible site visits, with
the Site Supervisor and the Student to ensure the quality of the educational
experience.
AJ Availability: I will be available as a resource to the Student and the Site Supervisor
should any concerns or issues arise.
AJ Evaluation: T will evaluate the extern's academic performance during the extemship.
The assessment will be based on the Student and Site Supervisor evaluations, timely
compliance with extemship requirements, the quality of self-reflection, and
professionalism. Based on this evaluation, I will determine whether credit should be
granted.
AJ Assistance and Support: I will contact the Site Supervisor orExternship Director
with any questions, concerns, or requests for additional support.
[AGREEMENT CONTINUES NEXT PAGE]

EXTERNSHIP EDUCATION AGREEMENT
PAGE 5
SPECIFIC EXPECTATIONS FOR THIS EXTERNSHIP
This section of the Agreement sets out specific means by which the Student, Site Supervisor and
Faculty Supervisor will meet key requirements. The student must complete this section after
consultation with the Site and Faculty Supervisors.
A. Student's Learning Goals
To work in the area of criminal law and gain substantial lawyering experience under
the supervision of a licensed attorney who practices criminal law.
Gain experience and practice translating criminal law for the public and media as it
relates to race, social justice, and immigration.
B. Student's Field Activities (must provide "substantial lawyering experience...that is
reasonably similar to the experience of a lawyer advising or representing a client or engaging in
other lawyering tasks," including opportunities for performance, not just observation)
My field activities should include (1) advising and representing a client before a
decision maker, (2) review and draft legal documents, (3) draft communications to
internal and external parties, (4) research relevant case law and statutes, (5) interview
and counsel clients, (6) negotiate, observe and participate in meetings with clients,
other lawyers, and decision makers, and (6) provide advocacy in court proceedings.

EXTERNSHIP EDUCATION AGREEMENT
PAGE 6
C. Plan for Site Supervision of Student (including feedback on student work)
My goals for the plan of supervision with my field supervisor are:
1. To approve a written education agreement that identifies:
(a) my learning goals;
(b) describes in specific terms the planned substantial lawyering experience and
opportunities for performance, feedback, and self-evaluation;
(c) sets out the respective roles of the faculty and field supervisors in supervising
the student and assuring the educational quality of the experience. T
2. Meet regularly with the supervisor throughout the externship to discuss and assess
the field activities, assignments, and progress toward meeting learning goals
3. Meet with supervisor periodically for feedback
D. Plan for Faculty Supervision of Student (including meetings, opportunities for
self-evaluation, and other requirements determined by the faculty supervisor)
Faculty supervision will be provided by the seminar portion of the externship, run by
Professor Ann Juergens with the assistance of Adjunct Professor Lynn Meyer.
E. Plan for Faculty Contact with Site Supervisor
The Externship Director or designee will contact Site Supervisors at new placement sites
before signing this agreement. For all placement sites, the Faculty Supervisor will contact the
Site Supervisor for at least one status report midway through the semester. MHSL will send a
follow-up survey instrument when the semester's work is completed. No credits or grade
(P/F) will be awarded until these steps have been taken.
Additional Faculty Contact with Site Supervisor:

EXHIBIT B

MARICOPA COUNTY EXTERNSHIP PROGRAM
ACKNOWLEDGMENT FORM
By signing this form I, , acknowledge the following:
1. The Extemship Program with the Office of the Legal Defender (the "Program") is approximately
weeks, for a minimum of hours per week (not to exceed hours per week), beginning
,20 and concluding , 20 .
2. In order to successfully complete the Program, I am required to participate for the duration of the term of the
Program.
3. It is my responsibility to seek academic credit from my college for my participation in the Program. The
County does not control eligibility for internship credit.
4. I have been notified of where I can view Maricopa County policies. If I fail to comply with any rules,
regulations, policies, or procedures of the County, such failure may result in disciplinary action, up to and
including dismissal from the Program.
5. Transportation to and from the Program is my sole responsibility, and shall not be the responsibility of the
County.
6. I am responsible for maintaining my own health insurance throughout the entire term of my participation in
the Program. In the event I am injured while on Maricopa County property, I will immediately notify my
assigned Program supervisor. I understand and agree that Maricopa County is under no obligation to provide
me medical services or transportation to obtain medical services.
7. I understand I have the responsibility to act professionally and appropriately at all times while participating in
the Program. If at any time I feel I am being treated unprofessionally or inappropriately, I have the right and
responsibility to report this directly to the Department of Human Resources.
8. I am not an employee of the County and therefore I will not be entitled any benefits normally associated with
employment with the County, such as, but not limited to, wellness programs, paid leave accrual, commuter
benefits, and health, behavioral health, pharmacy, vision, dental, life, and short term disability insurance
programs. Also, I will not be entitled to enroll in the Arizona State Retirement System or the County's
deferred compensation retirement plan as a result of my participation in the Program.
9. I am not entitled to any wages from the County and I will not be eligible for unemployment compensation
benefits when my internship ends, even if the County terminates my services.
10. My internship is at will, terminable at any time, and participation in or completion of the Program does not
entitle me to a job with the County or any of the protections afforded by A.R.S. § 11-351 et seq. (Arizona
laws governing county employee merit systems) or the Maricopa County Employee Merit System.
11. I understand that I may be exposed to confidential information while participating in the Program and I agree
to respect the confidential nature of all information whether in hardcopy or electronic form which may be
revealed to me in any manner. I also agree not to remove such information via copies or by other recording
means from County work locations.
12. My school and Maricopa County may exchange personal information about me, including information from
my educational records, in connection with my placement and participation in the Program.

13. I understand that there are certain dangers, hazards and risks associated with my participation in the Program.
I further understand that all risks cannot be prevented. I have considered the risks associated with
participating in the Program and knowingly and voluntarily assume all said risks. On behalf of myself, and
my family, heirs, assigns, and personal representatives, I hereby agree to indemnify, hold harmless, release
from liability and waive any legal action against Maricopa County, its governing board, officers, agents and
employees (collectively, "the Released Parties") for any personal injury, death, or property damage I may
suffer, due to any cause, including but not limited to the negligence of the Released Parties, arising out of or
in any way connected to my participation in the Program or while in transit to or from the site location(s) of
the Program.
I understand that by signing this document I am representing that I have read and understand all of its
terms and conditions and that I fully intend to be bound by the same. I also understand that I may
consult with an attorney prior to signing this document.
Signature: Date:
Print Name: