MILLS POLICE DEPARTMENT
CITIZEN RIDE ALONG
HOLD HARMLESS AGREEMENT / REGULATIONS
INSTRUCTIONS
Read the hold harmless agreement and the regulations. When you have read and understand the form in its entirety,
complete, sign and return the Agreement to the Mills Police Department. Mills Police Department supervisors will make
every attempt to facility a ride along, however, they reserve the right to deny a ride a long at any time for any reason.
FULL NAME (LAST, FIRST, MI):
HEIGHT:
WEIGHT:
HAIR:
EYES:
SEX:
ADDRESS:
CITY:
STATE:
DATE OF BIRTH:
SSN:
DO YOU HAVE A SPECIFIC OFFICER YOU WOULD LIKE TO RIDE WITH:
DO YOU HAVE A SPECIFIC DATE OR TIME YOU WOULD LIKE TO RIDE:
PHONE NUMBER:
HOLD HARMLESS AGREEMENT
I,
, wish to observe members of the Mills Police Department perform their duties. This observation will
include riding in police vehicles with members of the Mills Police Department. These activities may include situations where I may suffer damage
to my person or property.
I am freely and voluntarily requesting permission to participate in the Ride Along program. This program does not entitle me to, nor am I
requesting, any compensation. I certify that any services I will perform during the Ride Along program are done voluntarily. I understand that
permission to participate in this program may be revoked at any time.
In consideration of the above granted authority to observe and other good and valuable consideration, I, my assigned heirs, executors, or agents
hereby agree to hold the Town of Mills and the Mills Police Department harmless. I agree to indemnify the Town of Mills, the Mills Police
Department, and their agents and employees from any and all claims, damages, losses, and expenses arising out of the above described
observations, and related activities, which is for bodily injury, illness or death, or property loss of use.
REGULATIONS:
1. Participants shall wear professional casual clothing. Shorts, sleeveless shirts, and T-shirts will not be acceptable attire.
2. Participants shall be under the direct control of the police officer.
3. Officers will not allow participants to enter private homes or other areas where a citizen has a reasonable expectation of privacy without the
explicit consent of the citizen. Participants will also not be allowed to photograph and/or videotape within these same areas.
4. Participants shall conduct themselves in a civil and courteous manner at all times.
5. Participants shall not interfere with police officers while in the performance of their duties.
6. Participants shall not perform police duties. In an emergency, they may take appropriate action to protect themselves and/or officers.
7. Officers shall not engage in pursuits while participants are passengers in their vehicles.
8. Department Supervisors shall have the option to deny an individual's request to participate in the Ride Along Program.
9. Officers may request, through their immediate supervisor, that the Ride Along privileges of the participant be terminated for just cause.
10. Participants shall not carry weapons while they are participating in the Ride Along Program.
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Printed Name and Signature
Dated this day of
, 20 .
Printed Name and Signature of Legal Guardian (
If Applicable
)
/
/
Printed Name and Signature of Authorizing Supervisor
Dated this day of
, 20 .
Printed Name and Signature of Requesting Officer (
If Applicable
)
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