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<br />e <br /> <br />e <br /> <br />WAIVER; <br /> <br />Place: <br /> <br />Date: <br /> <br />I voluntarily agree to provide a specimen of my urine so <br />that it may be analyzed for the presence of drugs. <br /> <br />I understand that collection of the urine specimen may be <br />witnessed. <br /> <br />I hereby authorize the officers, employees, and agents of <br />the collecting and testing agencies to disclose, both orally <br />and in writing, the test results to the designated <br />representatives of the City. <br /> <br />For myself and successors, assigns, heirs, and executors and <br />administrators, I hereby release, absolve, remise, agree to <br />save harmless, forever discharge and hold free from all <br />harm, liability, or damage to me, the officers, employees, <br />and agents of the collecting and testing agencies and the <br />City from any and all suits, actions, or causes of action at <br />law, claim, demand, or liability which have now or may ever <br />have resulting directly, indirectly, or remotely from my <br />providing the said urine specimen so that it may be analyzed <br />for the presence of drugs. <br /> <br />(Printed Name) <br /> <br />(Signature) <br /> <br />(Date) <br /> <br />(Signature of Witness) <br /> <br />IDENTIFICATION OF THE PERSON GRANTING THE WAIVER: <br /> <br />Type of Picture ID Card Presented: <br />Serial Number of ID Card: <br /> <br />If no ID, Name of Person Who Vouched: <br />