Fill - Free fillable RIDE-ALONG PROGRAM APPLICATION (City of Stayton) PDF form

Stayton Police Department

386 N. Third Avenue

Stayton, OR 97383

Office: (503) 769-3423 ● Fax: (503) 769-4797

RIDE-ALONG PROGRAM APPLICATION

Last Name First Name Middle Name Maiden Name

Street / Mailing Address City / State Zip Code

Cell #: Home #: Work #:

DOB: DL #:

I hereby request permission to ride as a civilian observer in a Stayton Police Department patrol

vehicle because:

I further agree with and voluntarily sign the Release and Hold Harmless Agreement (on reverse).

All requested dates listed below are at least ten (10) days after submitting this application:

Choice:

Date:

Time:

Choice:

Date: Time:

Choice:

Date:

Time:

Signature of Applicant Date

For Office Use Only

Date / Time Received: Received By:

Checks: CCH Wanted DL RegJIN

Approved Denied Assigned By: Date:

Supervisor’s Name

Name of Officer Assigned to:

Ride Along Completed? No Yes – Date Completed:

Officer Comments:

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CITIZEN OBSERVER / RIDE ALONG PROGRAM

RELEASE AND HOLD HARMLESS AGREEMENT

In consideration of being permitted to ride in a vehicle owned and operated by the City of

Stayton, for the expressed purpose of observing operations and facilities of the Police

Department, the undersigned agrees to release and hold harmless the City, its agents,

employees and elected officials from any and all liability to me for personal injury or death or

any property damage, whether proximate or remote, sustained during or as a result of my ride

as an observer.

I understand that I will be a guest passenger in the vehicle in which I ride and have not offered

any payment to the Police Department or its employees for the opportunity to ride. I further

understand that I may be summoned as a witness in any proceeding as a result of my

observations.

This observation is for my educational benefit. At all times, I agree to obey all orders,

instructions and commands of the officer(s) of the Police Department. I fully realize and

appreciate the basic nature of law enforcement and the possibility that situations may arise

which might result in my exposure to danger of physical harm or injury, including traffic

accidents and I am willing to accept these risks. I further agree to keep confidential anything

which I may observe or hear. I understand that my observation ride may be terminated at any

time without notice.

I authorize the Police Department to conduct a complete records check of me prior to riding

and understand that any information of an adverse or criminal nature may disqualify me.

I freely and voluntarily sign this Release and Hold Harmless Agreement in sole reliance of my

own independent judgment.

Signature of Applicant Date

PARENTAL ENDORSEMENT (for applicants under age of 18 – minimum age requirement is 15

years): I have read and understand the Release and Hold Harmless Agreement and agree to be

bound to its provisions as they apply to my son / daughter, .

I agree to assume full responsibility for my son / daughter as it would pertain to the provisions

set forth.

Signature of Parent / Guardian Date

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Stayton Police Department

386 N. Third Avenue

Stayton, OR 97383

Office: (503) 769-3423 ● Fax: (503) 769-4797

CITIZEN OBSERVER (RIDE-ALONG) PROGRAM INFORMATION

The Citizen Observer (Ride-Along) Program follows established guidelines for the protection of the

observer. Deviation from these guidelines without the expressed consent of the host officer is cause for

immediate termination of the ride-along.

RULES OF CONDUCT

1. All information and observations acquired by the citizen observer during the ride-along shall be

considered strictly confidential unless otherwise stated by the host officer.

2. The citizen observer must realize that any action he / she witnesses during the ride-along may

require a court appearance at a later date.

3. Under no circumstances shall a citizen observer:

a. Be permitted to carry any weapon unless authorized and approved by the shift

supervisor.

b. Operate the patrol vehicle or any other equipment.

c. Act as an agent for the Department or otherwise perform any police-related duty.

d. Approach any vehicle on a traffic stop or approach any residence, building, or other

situation where the potential for violence exists or a crime is in progress.

e. Enter any crime scene of a serious nature (such as a homicide) and / or touch, possess,

tamper with or otherwise have contact with any evidence.

SAFETY CONSIDERATIONS

The physical safety of the citizen observer is of the utmost importance, therefore, host officers shall

weigh situations for potential hazards when responding to calls.

In cases of possible extreme danger (i.e. person with gun), the citizen observer may be let out of the

patrol vehicle at a safe distance from the area unless qualified to assist. In situations with a potential for

violence (fights, family disturbances, etc.), the citizen observer shall remain in the patrol vehicle unless

qualified to assist.

ADDITIONAL INFORMATION

A ride-along shall last a maximum of five hours. No more than one ride-alongs shall be granted in a

calendar year, unless authorized by the shift supervisor. Minimum age requirement is 15 years old.

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Fillable RIDE-ALONG PROGRAM APPLICATION (City of Stayton)

Fill Online, Printable, Fillable, Blank RIDE-ALONG PROGRAM APPLICATION (City of Stayton) Form

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