1. PARTICIPANT DETAILS
- 1.1 Full Name: Will Grigg
1.2 Date of Birth: 30/APR/1998
1.3 Phone Number (Optional): 5219132
1.4 Have you attended the Traffic Safety Program within the last 30 days?: No
2. REQUEST DETAILS
- 2.1 When will you be available for a Traffic Safety Program session? (( All times are in UTC ))
Mark each box by changing [cb] to [cbc]
Morning (6 am - 12 pm)
Noon (12 pm - 6 pm)
Evening (6 pm - 12 am)
Night (12 am - 6 am)
3. RELEASE & WAIVER
I, the undersigned, hereby agree that except for the active negligence or willful misconduct of City or any of its Boards, Officers, Agents, Employees, Assigns, and Successors in Interest, I undertake and agree to defend, indemnify, and hold harmless the City and its Officers, Agents, and Employees against any loss, cost, expense, injury, damage, or liability incurred by reason of any personal injury or property damage sustained by myself, caused or resulting from my participation in this program.
I, the undersigned, hereby agree that should I fail to attend within the next two planned sessions of the program hosted by the Los Santos Police Department, my application to the program shall be revoked and I must reapply to be permitted to attend any future programs.
I, the undersigned, also agree that I shall not disturb, obstruct or otherwise impede the Traffic Safety Program or its participants. Shall I fail to remain civil and cordial during the duration of the program, I understand that I may not receive the promised benefits of completing the program and may be removed and/or barred from future participation.
I, the undersigned, hereby agree that should I fail to attend within the next two planned sessions of the program hosted by the Los Santos Police Department, my application to the program shall be revoked and I must reapply to be permitted to attend any future programs.
I, the undersigned, also agree that I shall not disturb, obstruct or otherwise impede the Traffic Safety Program or its participants. Shall I fail to remain civil and cordial during the duration of the program, I understand that I may not receive the promised benefits of completing the program and may be removed and/or barred from future participation.
- 3.1 Signature:

3.2 Date Signed: 07/OKT/2025








POLICE OFFICER III+1




