Lock Out Form Minnetonka Police DepartmentVehicle and Lock-Out AssistanceRelease and Indemnity Agreement Date MM slash DD slash YYYY Badge Vehicle License Driver Name Driver License # State Location Incident Number Type of Assistance Lock Out Pushed Vehicle I request that this representative of the City of Minnetonka assist me with this vehicle. I realize that the City of Minnetonka has no duty to provide this service. I therefore agree to assume full responsibility for any damage that may result to this vehicle and will not make any claim against the city, its officials or employees. If someone else makes a claim against the City, its officials, or employees for the damage, I will pay the City for all its expenses in responding to or paying that claim. I have read and fully understand the above paragraph and voluntarily sign this document and agree to its terms.Vehicle Driver/Owner or RepresentativeSignatureDate MM slash DD slash YYYY EmailIf you would like a copy of this form, please enter your email address below