Ride Along Request Form

Ride Along Request Form

Please fill in the form below.
Full Name

First NameLast Name
Date of Birth (MM/DD/YYYY)
Last 4 of SSN
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Drivers License number
Drivers License issuing state
E-mail
Affiliation
Emergency Contact
Have you requested a ride along with our organization in the last twelve (12) months?
Enter your desired dates for ride along. Dates must be at least seven (7) days after application submission
Desired Date
Time Request
Desired Date
Time Request
Desired Date
Time Request

What is the reason for your ride-along request? (School/class, interested citizen, etc.)
Have you ever been convicted of a crime?
If yes, for what?

FULL RELEASE AND HOLD HARMLESS AGREEMENT TO PARTICIPATE IN DESCHUTES COUNTY SHERIFF’S OFFICE RIDE-ALONG PROGRAM
In consideration of being permitted to ride in a vehicle owned and operated by Deschutes County for the express purpose of observing operations and facilities of the Deschutes County Sheriff’s Office, I agree to Release and Hold Harmless, without limitation, Deschutes County, its employees, elected officials, and agents from any and all liability for personal injury or death and/or any property damage, whether proximate or remote, sustained during or as a result of my participation as an observer.

I understand that I will be a guest passenger in the vehicle in which I ride and have not offered any payment to the Deschutes County Sheriff’s Office or its employees for the opportunity to ride. This observation is for my educational benefit. At all times, I agree to obey all orders, instructions and commands of the employees of the Deschutes County Sheriff’s Office. I understand that my participation in this program may be terminated at any time without notice. If emergency circumstances dictate, I may be dropped off in the field at a safe location.

I fully realize and appreciate the nature of law enforcement as a dangerous activity and the possibility that situations may arise which might result in my exposure to danger of physical harm or injury, including but not limited to traffic accidents, use of weapons, unlawful acts, forcible resistance by criminal suspects, assault and furthermore I am fully aware that there may be risks and hazards unknown to me connected with being an observer in this activity, and I am voluntarily willing to accept full responsibility for all of these above risks of loss, property damage or personal injury, or death, whether caused by the negligence of releasees or otherwise.

I further agree to keep confidential anything I observe or hear. I further understand that I may be summoned as a witness in court or other proceedings as a result of being a participant in this program.

It is my express intent that this Release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a Release, Waiver, Discharge and Covenant Not to Sue the above named releasees. No oral representation, statements or inducements, apart from this written agreement have been made.

I authorize the Sheriff’s Office to conduct a complete records check on me (including criminal history) prior to riding and I understand that any information of an adverse or criminal nature may disqualify me.

I freely and voluntarily sign this Release and Hold Harmless agreement in sole reliance of my own independent judgment.
I have read and acknowledged the Full Release and Hold Harmless Agreement
Should be Empty:

Ride Along Request Form

Enter your desired dates for ride along. Dates must be at least seven (7) days after application submission