Embracing our Heritage, Advancing our Future”
DOUGLAS POLICE DEPARTMENT
Ride-Along Authorization and Indemnification Waiver
Name
Date of Birth
Home Address
City
State
Zip Code
Home Phone
Cell Phone
Occupation
E-mail Address
Reason for Request Ride along form for: Patrol
Communications
Do you have a disability that may require accommodations? Yes
No
If so, please describe
A copy of your Driver
s License or other photo ID must be attached to this form when submitting it for consideration.
Dress is business casual. NO JEANS allowed.
THIS IS A RELEASE OF LIABILITY PLEASE READ CAREFULLY BEFORE SIGNING
In consideration of the training and/or education I will receive by being allowed to accompany one or more police officers of the City
of Douglas Police Department, I, the undersigned, acknowledge and fully understand I will be engaging in activities that involve risk of
serious injury or death which might result from my own actions or inactions, the negligence of others, and the risks inherent in
accompanying a police officer in the normal course of his or her duties. I assume and accept personal responsibility for all such risk. I
am aware the passenger-side airbag in the vehicle is deactivated, and I assume and accept personal responsibility for any increased risk
associated with that deactivation. (initials) .
I further agree to indemnity and hold the City of Douglas and its officers, employees and agents harmless from any loss, damage or
injury to me while accompanying a City of Douglas police officer in the course of his/her duties or otherwise. If I am under 18, my
parent(s) or guardian(s) also agree to indemnify, defend and hold the City of Douglas and its officers, employees and agents harmless
from any loss, damage or injury to the minor while accompanying a City of Douglas police officer. This indemnification applies to
losses, damages or injuries caused or alleged to be caused, in- whole or in part, by the negligence or conduct of the City of Douglas or
its officers, employees or agents. This release of liability applies to me, the undersigned, and to any of my personal representatives,
assigns, heirs and next of kin.
I further expressly give consent to the Douglas Police Department to initiate a background check on me and certify the above listed
information is accurate and true.
I have read the waiver and release. I understand I have given up substantial rights by signing it, and I sign this waiver and release
voluntarily.
Signature Date
Parent/Guardian (if under 18) Date
Parent/Guardian (if under 18) Date
Embracing our Heritage, Advancing our Future”
Ride-Along Authorization and Indemnification Form (Cont.)
Name:
Date of Ride Along:
Officer Assigned:
Form Completed and Assigned By:
Yes No
No
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