Ride with Afterlife Application Form
Complete the form below, and we’ll be in touch after reviewing your application
Full Legal Name
*
First Name
Last Name
Preferred / On-Camera Name
*
Date of birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
First Name
Last Name
Relationship to Emergency Contact
*
Please Select
Options:
Parent / Guardian
Spouse / Partner
Sibling
Child
Friend
Relative
Other
Occupation / Profession
Organization / Company (if applicable)
Social Media Handles (if applicable)
Please include any social media accounts you would like us to be aware of (Instagram, TikTok, Facebook, X, LinkedIn, etc.).
Upload a Headshot / Photo
Browse Files
Drag and drop files here
Choose a file
Please upload a recent photo if appropriate.
Cancel
of
T-Shirt Size
*
Please Select
Options:
XS
S
M
L
XL
2XL
3XL
4XL
5XL
Other
Can you operate a motor vehicle and do you have a valid driver's license? (This will not affect program approval)
*
Yes
No
Are you able to lift 100–400 lbs?
*
Yes
No
I am unsure / would like to discuss
Do you have any food or chemical allergies?
*
Please list any known allergies or sensitivities. If none, enter "None."
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Participant Type
Let us know which role you’re interested in.
Which best describes your role in the Ride With AfterLife Program?
*
Ride-Along Participant
Guest / Interviewee
Mental-Health Professional
Law-Enforcement Professional
Mortuary / Funeral Professional
Business / Community Leader
Other
Are you 18 years of age or older?
*
Yes
No
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Legal Guardian Information
This section is required for participants under 18 years of age.
Guardian Name
First Name
Last Name
Guardian Email
example@example.com
Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Participant
Please Select
Parent
Legal Guardian
Other
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Your Story & Background
The following questions help us better understand your story, your motivations, and what you hope to gain from participating in the Ride With AfterLife Program. Please share only what you are comfortable sharing.
Please describe your primary motivations for participating in the Ride With AfterLife Program.
*
What key issues do you hope or expect this program will help address or resolve?
*
Has anyone close to you experienced the loss of life due to preventable causes, such as drug overdose, domestic violence, alcoholism, homicide, suicide, or a health condition?
Yes
No
Prefer not to answer
If you feel comfortable sharing, please tell us a little about your experience and how it has impacted you.
Have you sought professional assistance or additional resources to address concerns regarding your teenager's behavior?
*
Yes
No
Currently seeking assistance
Not applicable
Prefer not to answer
If you are comfortable sharing, please describe the type of professional assistance or additional resources you have sought.
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Consent
*
I confirm that the information I have provided is accurate to the best of my knowledge.
I understand that submitting this form does not guarantee acceptance into the Ride With AfterLife Program.
Sign Form
Signature
Submit
Submit
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