RIDE-ALONG REGULATIONS, APPLICATION, AND WAIVER FORM

Ride-Along

Regulations, Application, and Waiver Form
Regulations
The ride-along is an observer only, and should not become involved in or interfere with any situation, either physically or verbally.

Ride-alongs should be dressed in either business attire or neat, clean, casual attire. Jeans, shorts, spandex, leggings, T-shirts and sweats are not acceptable.

Participants will not be allowed to carry a weapon while on a ride-along, despite current concealed weapon laws.

Cameras and tape recorders are not permitted.

5. safety; however, they may not leave the vehicle unless given permission to do so by the technician. In compliance with a Supreme Court Ruling ride-alongs are prohibited from entering any private residence for any reason.

Ride-alongs will be allowed to observe as much of any situation as is possible, consistent with their

6. opportunity to eat a meal; however, this will depend on the level of calls for service.

Ride-alongs must pay for their own food and beverages. If at all possible, they will be given an

The technician may terminate the ride if the participant fails to follow the regulations or is acting in a manner inconsistent with the best interests of the company.

The participant may request that the ride be terminated at any time. The participant will be returned to the garage as soon as the technician determines it is practical.
WAIVER AND RELEASE OF CLAIM
As a condition precedent to being permitted to ride as a Ride-Along Observer in a vehicle or vehicles operated by any technician or person employed by MISTER ROADSIDE ASSISTANCE OF HOUSTON, I the undersigned, waive any claim I may have against MISTER ROADSIDE ASSISTANCE OF HOUSTON and employees for any loss of life, bodily injury, property damage or any other claim whatsoever that I may sustain as a result of riding as such Ride-Along Observer. I further agree that this waiver of liability by me is binding on my legal representatives, heirs and successors, and shall have the same legal effect as I have agreed to herein.
Signature of Participant*
PARTICIPANT's PRINTED NAME*
Signature of Witness*
Ride-Along Application
NAME*
First & Last Name
DATE OF BIRTH*

MonthDayYear
Date
RACE
SEX
AGE*
HOME ADDRESS*
CITY*
STATE*
ZIP CODE*
SOCIAL SECURITY NUMBER*
HOME PHONE*
BUSINESS NAME
BUSINESS PHONE
IN CASE OF EMERGENCY NOTIFY*
First & Last Name
PHONE*
RIDING TIME DESIRED: (CHECK ONE)*

DAY SHIFTEVENING SHIFTMIDNIGHT SHIFT
DAY OF WEEK DESIRED*
2ND CHOICE OF WEEK*
HAVE YOU PARTICIPATED IN A RIDE-ALONG WITHIN THE LAST 12 MONTHS?*
WHAT PROMPTED YOUR INTEREST IN THE RIDE-ALONG PROGRAM?
MISTER ROADSIDE ASSISTANCE OF HOUSTON's Use Only
Court Record(s)

NO RECORDRECORD ATTACHED
File Upload

Cancelof
APPLICATION STATUS
APPROVEDDISAPPROVEDTERMINATED
TO BE COMPLETED by Supervisor
COMPUTER CHECK MADE?
Date (format - mm/dd/yyyy)
COMPUTER CHECK MADE? APPLICANT NOTIFIED?

APPLICANT NOTIFIEDAPPLICANT NOT NOTIFIED
BY
DATE AND TIME SCHEDULED RIDE-ALONG
SCHEDULED RIDE-ALONG

MonthDayYear
Date
SCHEDULED RIDE-ALONG

Hour Minutes

AM/PM Option
ASSIGNED TO EMPLOYEE
TO BE COMPLETED BY TECHNICIAN
WOULD YOU RECOMMEND THE INDIVIDUAL BE ALLOWED TO RETURN FOR ANOTHER RIDE-ALONG?

YESNO
IF NO, PLEASE EXPLAIN
SUPERVISOR SIGNATURE
DATE

MonthDayYear
Date
Should be Empty:

Ride-Along

Regulations

WAIVER AND RELEASE OF CLAIM

Ride-Along Application

MISTER ROADSIDE ASSISTANCE OF HOUSTON's Use Only

APPLICATION STATUS

TO BE COMPLETED by Supervisor

DATE AND TIME SCHEDULED RIDE-ALONG

TO BE COMPLETED BY TECHNICIAN