I recognize that participation in this Program is strictly voluntary and that such participation is not within the course and scope of my employment. I request to register my participation in this Program. I hereby assume full responsibility for all risk of injury and loss, including death, which may result from my participation in the program. I agree to hold harmless, release, waive, forever discharge, and covenant not to bring suit or claim against 511 Contra Costa, West Contra Costa Transportation Commission (WCCTC), Southwest Area Transportation Committee (SWAT), Advanced Mobility Group (AMG), Contra Costa Transportation Authority (CCTA) or their respective officers, agents, and/or employees from any and all claims and demands which I may have against 511 Contra Costa, WCCTC, SWAT, AMG, CCTA, the Company, or their officers, agents, or employees, by reason of an accident, illness, injury, or death, or damage to or loss of or destruction of any property arising during such participation, or any time subsequent thereto, whether or not such loss, injury, or death is caused or alleged to be caused in whole or in part by the negligent acts or omissions of 511 Contra Costa, WCCTC, SWAT, AMG, CCTA, the Company, or their officers, agents, or employees. The terms of this release are binding on my heirs, executors, administrators, and for all of my family members as well as myself. I have read the foregoing paragraph and fully understand the terms contained therein and submit this waiver freely and without inducement.

I recognize that fraudulent or falsified applications may result in a ban from the program and a report to authorities.

By applying for this incentive, you agree to participate in a follow up survey to help us assess program effectiveness. You agree to receive email communications from 511 Contra Costa, including being signed up for the newsletter. You can opt-out at any time.