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:
1
st
Choice:
Date:
Time:
2
nd
Choice:
Date: Time:
3
rd
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.