Page 1 of 3 - PD-9 - (04/28/10)
RIDE-ALONG APPLICATION
PD-9
Revised 04/28/10
Richmond Police Department
Richmond, Virginia
Date:
RIDE-ALONG APPLICATION
Please provide the requested information and return to: Headquarters at 200 W. Grace Street, Richmond, Virginia
23220 or any Precinct.
First Precinct
2501 Q Street
Richmond Virginia 23223
Second Precinct
177 E Belt Blvd
Richmond Virginia 23224
Third Precinct
301 South Meadow St
Richmond Virginia 23220
Fourth Precinct
2219 Chamberlayne Ave
Richmond Virginia 23222
Community, Youth & Intervention Unit
Citizen Participants
Personnel & Recruitment Unit
Applicants for RPD
Public Affairs Unit
Media Personnel
Full Name: Sex: Race:
First Middle Last
Home Address:
Street City State Zip
Date of Birth: Place of Birth:
Social Security Number:
Home Phone Number: Business Phone:
If you’d like to be contacted via email, please provide email address:
Please provide a phone number where you can be reached
between 8:30 A.M. and 5:00 P.M. to verify the approval to ride:
Have you ridden with the RPD in the last 12 months? Yes No
If yes, when:
Do you have any mental and/or physical impairment? Yes No
If yes, please explain:
Have you ever been convicted of a Misdemeanor or Felony? Yes No
If yes, please explain:
By signing this form, I certify that the above information is correct. I also
authorize the Richmond Police Department to conduct a criminal records
check to determine by eligibility to participate in this program.
Signature
During this Ride-Along you will be a silent observer. We request that you do not reveal what you see or hear during the tour that
could be detrimental to the prosecution of any cases arising from the officer’s performance of duty. You may be called upon to be a
witness in a court proceeding and you may be called upon for assistance. The decision for this will rest upon the officer to whom
you are assigned and the circumstances.
All participants are expected to wear businesslike attire or neat casual attire, unless further approval is granted by the Chief of
Police or designee. Participants must be at least 18 years of age unless further approval is granted. Ride-Along participants will
not be permitted to carry weapons of any kind. Cameras or tape recorders are not permitted unless prior approval is granted by the
Chief of Police or designee.
The Richmond Police Department’s Ride-Along Program is a privilege extended to persons who are interested in observing the
police officer, his/her duties and how he/she interacts with the community. The Department reserves the right to refuse participation
in the program.
Conviction of any felony or of a misdemeanor involving moral turpitude may prohibit the applicant from participating in the program.
All other misdemeanor convictions will be considered on a case-by-case basis.
Page 2 of 3 - PD-9 - (04/28/10)
RIDE-ALONG APPLICATION
PD-9
FOR OFFICE USE ONLY:
Date received and sent for record check:
Criminal records check completed by:
Date approved/disapproved: Approved Disapproved
Date contacted:
Date assigned:
Relief assigned:
Date sent to Precinct:
TO BE FILLED OUT BY THE SUPERVISOR AND RETURNED TO THE FORWARDING UNIT
INDICATED ON THE FRONT OF THE APPLICATION WHEN THE RIDE-ALONG APPLICANT
HAS COMPLETED THE TOUR:
Assigned to ride with: Code #: Unit:
By:
Supervisor
Time: Date:
Total duration of Ride-Along:
Supervisors: Please return the completed Ride-Along Form and Waiver of Liability Form to the Community, Youth
and Intervention Unit when the Ride-Along has completed the tour.
Page 3 of 3 - PD-9 - (04/28/10)
RIDE-ALONG APPLICATION
LIABILITY EXEMPTION
RICHMOND POLICE DEPARTMENT
RICHMOND, VIRGINIA
Date:
I hereby release the City of Richmond, Virginia and any member of
the Richmond Police Department from any and all liability directly or
indirectly arising out of my riding in a police unit with a police officer of
the City of Richmond, Virginia.
Signature:
Witnesses:
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