First, middle, Last name: ____________________________________________
Address: _____________________________________________________________________________
Driver’s License number and state of issue:_________________________________________________
Phone number: ________________________Date of Birth: ____________________________________
Email address: ________________________________________________________________________
Emergency Contact (Full Name, address, phone number, relationship: __________________________
Preferred Day(s) of week: __________________________ Preferred times: ______________________
Preferred Officer (if any): ____________________Reason for Ride Along: ________________________
Do you have any needs that require consideration: __________________________________________
Are you an employee of the University of Alaska:___________________________________________
This form must be completed and returned to the UAF Police Department at least 72 hours before the
date requested. Submittal of form does not mean the request has been approved. Back ground
checks will be performed on all requesters prior to the approval to participate. You will be contacted
by UAFPD to inform you of request status. During that contact, the date, time and officer assignment
will be established if the request has been approved. Ride Along applicants will be given a safety
briefing at the time of the ride along. Any questions concerning ride- alongs should be addressed to
Patrol Supervisor at 474-7721.
Riders are expected to be physically able to handle themselves in the event of an emergency or critical
incident. Please clearly indicate any special needs or conditions that may impact this ability. A photo
ID must be provided at the time of the ride along. UA is an AA/EO employer and educational
institution and prohibits illegal discrimination against any individual:
Applicant Signature: ______________________________________ Date: _____________________
*Please read and initial the following statements. Every person going on ride-alongs must
sign the UAF Police Department Ride-Along Agreement and the University of Alaska Release
____ The officer I have been assigned to ride with has given me a safety briefing and the
opportunity to ask questions that may clarify any requirements (initial at time of ride along).
____ I have voluntarily requested to ride as a passenger and observer in a UAFPD vehicle that
will be operated by official Law Enforcement personnel while performing official duties as a
peace officer.
____ I understand that the activities of the officer I am assigned to ride with may be dangerous,
involving possible risk of personal injury and damage or loss of property.
____ I understand that I am to obey the commands of the officer at all times during the ride-
along. I will not take any action that will inhibit the actions of the officer I am assigned to or
that will jeopardize the safety of myself and/or the officer.
____ I understand the equipment assigned to an officer and the vehicle in which I will ride is for
the purpose of aiding the officer in performing official duties only and I will not touch, utilize, or
adjust any of the equipment in the vehicle or on the officer.
____ I understand that failure to abide by the above requirements will result in immediate
termination of the ride-along, can prohibit me from future ride-along consideration and could
result in injury, death, civil liability or, if I intentionally interfere with police activity, could result
in criminal charges against me.
____ I understand that a back ground check will be performed before I am allowed to
**Ride Along’s Signature: _________________________________ Date: _________________