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and he/she will not be allowed to ride (City of Gonzales)

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U.S.A. forms for City of Gonzales

BROWSE CITY OF GONZALES (CA) FORMS

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Gonzales Police Department
READ THE FOLLOWING BEFORE SIGNING THIS APPLICATION
AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE WAIVER AND RELEASE OF CLAIMS.
The undersigned agrees that he/she, his/her estate and/or heirs shall hold harmless the City of Gonzales, it’s
Officers, employees, and agents from and against charges and expenses (including attorney fees) and cause of
actions of whatsoever character which the City of Gonzales may incur, sustain or be subject to on account of loss or
damage to property and loss of the use thereof and for bodily injury to or death of the undersigned arising while a
guest or observer in any city of Gonzales vehicle or while accompanying a member of the Gonzales Police
Department during the active performance of his/her official duties.
Applicants Signature:
Date:
For Office Use Only
Officer rode with:
Time
Date:
Approving Supervisor’s Name:
Request APPROVED by:
Request DENIED by:
Next of Kin:
Relationship:
Address
Telephone #:
Note: If the participant is under 18 years of age, a parent/guardian must be present to complete the Ride-Along Form
and he/she will not be allowed to ride past 10:00 p.m.
Any person approved to ride along is required to be suitably dressed in collared shirt, blouse or jacket, slacks and
shoes. The ride along will be refused to anyone not properly dressed.
Reason for request to participate in the ride-along program:
Parent/Guardian signature if participant under the age of eighteen (18)
Date:
Name:
Date of Birth:
Address:
Home Phone:
Business Phone:
Driver License / I.D #:
Height:
Weight:
Hair Color:
Eye Color:
Parent / Guardian Name:
Parent / Guardian Signature:
Date:
SERVE • CARE • CONNECT
Ride Along Application
Departamento de Policía de Gonzales
LEA LO SIGUIENTE ANTES DE FIRMAR ESTA APLICACIÓN
ACUERDO QUE ASUME EL RIESGO DE LESIÓN O EXENCIÓN DE DAÑOS Y LIBERACIÓN DE
RECLAMOS.
El abajo firmante acepta que él / ella, sus bienes y / o herederos mantendrán indemne a la Ciudad de Gonzales, sus
oficiales, empleados y agentes de y contra los cargos y gastos (incluidos los honorarios de abogados) y la causa de
las acciones de cualquier carácter que la ciudad de Gonzales puede incurrir, sostener o estar sujeto a causa de la
pérdida o daño a la propiedad y la pérdida del uso de la misma y por lesiones corporales o la muerte del abajo
firmante que surja mientras un invitado u observador en cualquier ciudad de Gonzales vehículo o mientras
acompañando a un miembro del Departamento de Policía de Gonzales durante el desempeño activo de sus deberes
oficiales.
Firma del Aplicante:
Fecha:
Sólo para uso de oficina
Nombre de Official:
Tiempo:
Fecha:
Nombre de Supervisor:
Solicitud APROVADA por:
Solicitud NEGADA por:
Pariente más cercano:
Relación:
Dirección:
Número de teléfono:
Nota: Si el participante es menor de 18 años, un padre / tutor debe estar presente para completar el Formulario de
Ride-Along y no se le permitirá viajar después de las 10:00 p.m.
Se requiere que todas las personas aprobadas para viajar a lo largo estén vestidas adecuadamente con camisa de
cuello, blusa o chaqueta, pantalones y zapatos. El viaje será rechazado a cualquier persona que no esté vestida
adecuadamente.
Motivo de la solicitud para participar en el programa de acompañamiento:
Firma del padre / tutor si el participante es menor de dieciocho (18) años
Fecha:
Nombre:
Fecha de nacimiento:
Dirección:
Teléfono de casa:
Teléfono de negocios:
Licencia de conducir / I.D. #:
Estatura:
Peso:
Color de pelo:
Color de los ojos:
Nombre del padre / tutor:
Firma del padre / tutor:
Fecha:
KEITH WISE
JEFE DE POLICIA
SERVE • CARE • CONNECT
Solicitud de Acompañamiento
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and heshe will not be allowed to ride (City of Gonzales)

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Completed 13 August 2020

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