Citizen Ride-Along Application
Complete form and return to:
Evans Police Department
1100 37
Evans, CO 80620
Date of application: _____________________
Note: This request should be submitted to the Evans Police Department at least 10 days prior
to the day you wish to ride. You will be contacted after the request is processed.
Please PRINT the following:
First Middle Last
Number and Street City and State Zip
DATE OF BIRTH: _____________ GENDER: _______ AGE: _________
HOME PHONE: _______________ WORK PHONE: ______________
DRIVER’S LICENSE # (or other ID): __________________ / State ______________
OCCUPATION / EMPLOYER: ____________________________________________
DATE YOU WISH TO RIDE: _________________________
FROM: ___________ a.m. / p.m. TO: ___________ a.m. / p.m.
I PREFER TO RIDE WITH OFFICER: ____________________________________
Relationship to Officer, if any: _____________________________________________
DATE OF LAST RIDE ALONG, if applicable: ________________
(No more than one ride along per 6-month period unless approved by Patrol
I am aware of the risks and hazards inherent in accompanying one or more Evans Police
Department Police Officers when on duty, and do hereby voluntarily assume all risk of loss,
damage or injury to me or to my property, including death, which may be sustained while or
incidental to accompanying one or more Evans Police Department Police Officers while on
In consideration of permission which I have received to accompany one or more Evans Police
Officers of the Evans Police Department, of the City of Evans, Colorado, a municipal
corporation, in the course of their duty, I, the undersigned, do, by these presents, release the
City of Evans, its Police Officers, and public officials from all liability in any causes of action
which I may hereafter have on account of any and all injuries and damage to me or to my
property, or on account of my death, arising out of or related to any happening or occurrence
while accompanying any Police Officer of the Evans Police Department on duty, or incidental
thereto, and for the same consideration, I promise to release and covenant not to sue the said
City and the said persons, and agree to forever hold them and each of them harmless from any
such liability, claims, demands, actions or causes of action.
The terms hereof shall be in full force and effect on the date hereof and on any other occasion
when I may hereafter accompany any Evans Police Department Police Officer.
This release and agreement shall be binding upon me and my heirs, executors, administrators,
personal representatives and assigns, and shall inure to the benefit of the said City, officers and
agents, public officials and persons herein designated, and their heirs, executors,
administrators, personal representatives, assigns and successors in office.
DATED this ________ day of _____________________, 2________ .
Signature Date of Birth Age
Address City / Sate Zip
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I / We, the undersigned, represent that I/we are legally appointed or natural guardian(s) of the
above named person who is under the age of eighteen years; that he/she has signed the within
and foregoing document with our full knowledge and consent; and the I/we join in the
execution of the same and agree to the terms thereof and do hereby find myself/ourselves in
independent agreement to the same terms and provisions for myself/ourselves and my/our
heirs, executors, personal representatives, and assigns.
Printed Name Relationship
Signature Date
For Official Use Only
Approved ________ Denied ________
_______________________________________ __________
Command Officer’s Signature Date
Date/Time Completed Ride Along
_______________________________________ __________
Officer’s Signature Date
Criminal History Attached: Yes No
Applicant Notified: ________________
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