Department Standard Operational Procedure – Chapter 28
June 2018
6
Limited Liability Release Form
In consideration of being allowed to accompany Leander Police Officers on official patrol and otherwise participate in the Ride Along
Program:
I, the undersigned, binding my heirs, executors, administrators, and assigns, do hereby release and agree to hold harmless, the City of
Leander, its officers, agents, and employees and especially Officer from any and all actions,
causes of action, claims, demands, costs or damages arising from or resulting from property damage, personal injuries or death
sustained by me while participating in the rider program, whether or not such damage or injury was caused or contributed to by any
acts or omissions, including negligent acts or omissions, of any other person or persons. I further agree, binding my heirs, executors
administrators and assigns to indemnify the City of Leander, its agents, officers, and employees, and especially the above named
officer, from and against any liability, action, claim, damage, award or judgment incurred or suffered by the above city or individuals
as a result of any act or omission by me or caused in whole or in part by me while participating in the rider program whether or not
also caused in part by a person indemnified hereunder. In addition, I make the following representations and acknowledgments upon
which I intend the City of Leander to rely:
1. I understand and agree that while accompanying any police officer during his law enforcement tour, I am to be only an
unarmed, lay observer and bystander, with no active role whatever and that I will have and am given no duties, rights, powers
of authority whatever other than those conferred by law upon any other person in like or similar circumstances as may arise
from time to time.
2. I realize and agree that while participating in the rider program, I will not be an agent, servant, or employee of the City of
Leander and therefore will not be covered by the City of Leander for any workers compensation, death or disability benefits.
3. I realize and acknowledge that there is an element of danger inherent in riding with a police officer on duty. It is foreseeable
that situations may arise at any time, suddenly and without warning, in which I may be placed in great physical danger. I
knowingly and willingly agree to assume these risks. I agree that neither the City of Leander, nor any of its officers or
employees shall be obligated to take any extraordinary steps to protect my person or to provide a means of withdrawal or retreat
for me, and I release them from any duty to do so.
4. I agree that any information that I may gain, through participation in the program, will be used by me only for my personal
education purposes except where I am summoned as a witness in any administrative or court proceeding.
5. I understand that my participation in the above named program is a privilege subject to revocation at any time by the City of
Leander, whose decision in the matter will be binding.
Rider name, printed Rider signature Date
