Forms • Town of Christiansburg • CivicEngage

Citizen's Academy

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Name:*

Address:*

Email:

How long have you lived in Montgomery County?*

Why do you want to participate in the Citizens Academy?*

Please list any dates you may not be able to attend:

Release of Liability: I hereby request authorization to participate in the Montgomery-Christiansburg Citizens Academy. I understand that tours and other activities may include a risk of personal injury and/or personal property damage; and I make this request with full knowledge of these risks. I agree to hold Montgomery County and the Town of Christiansburg, and their agents, volunteers, and personnel, harmless from any and all claims, actions, suits, and/or injury that may arise from my participation in the above mentioned program.

I agree to the release of liability.

I do not agree to the release of liability

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