Oxnard Fire Department
Ride-Along Application
To be completed by applicant
Applicant name: Phone No.
Date of birth:
Age: Sex: M F
Address:
Number Street City State Zip
Check One: ___ Enrolled in Fire Science program ___ Member of news media
___ Government Official ___ Member of other fire agency
In case of emergency or accident, contact (nearest relative):
Name Address Phone Number
Family doctor or medical services requested in case of injury or illness:
Name Phone Number
Agreement Assuming Risk of Injury or Damage
Waiver and Release of Claims
Whereas the undersigned, not being a sworn member, employee, or agent of the Oxnard Fire
Department, has made a voluntary request for permission to participate as a ride-along in a fire
department vehicle, at a time when such vehicle is operated and staffed by members of the Oxnard
Fire Department and has further requested permission to accompany a member or members of said
fire department during the active performance of their official duties as fire officers; and
Whereas, the undersigned acknowledges that the work and activities of said fire department are
inherently dangerous involving possible risk of injury, damage, expense, or loss to person or property
and further agrees that the said fire department did not take the initiative in extending an invitation to
be a ride-along of or accompany its members.
Now, therefore, be it understood that the undersigned hereby agrees that the City of Oxnard, the
Oxnard Fire Department, the driver or owner of any vehicle owned or operated by or in the service of
the City of Oxnard, their officers, agents, employees, directors, or sureties, and each of them, shall
not be held liable or responsible under any circumstances whatsoever by the undersigned, his or her
estate, or heirs, for any claim or lawsuit for any injury, damage, expense, or loss to the person or
property of the undersigned, incurred while participating as a ride-along in any Oxnard Fire
Department vehicle or while accompanying a member of said department during the active
performance of the member's official duties.
I have read, understand the above, and I have not been on a ride-along in the last 90 days:
Applicant's Signature Date
Must fill out reverse side
G:\Admin Forms\Ride Along Form.pdf
