Ride Along Application

Basic Information

Name *

First

Last

Date of Birth *

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Driver's License Number *

Why do you want to participate in this program? *

Have you participated in our "RIDE-A-LONG program" in the past? *

Yes
No

Past Ride A Long Participation Date

Have you ever been arrested? *

Yes
No

If "Yes" explain:

PLEASE GIVE TWO WEEKS ADVANCE NOTICE FOR PROCESSING

Available Shifts:

Days: 0600-1600, 0800-1800
Swing: 1500-0100
Graves: 2100-0700

Shift Preference *

Date Preference *

Medical History

High Blood Pressure *

Yes
No

Heart Condition *

Yes
No

Nervous or Mental Condition *

Yes
No

Serious Mental Condition *

Yes
No

Dress code: Ride-a-longs shall be required to be neatly dressed in casual business attire.
Applicants must be 18 years of age or older at the time the application is submitted. Exceptions are made with the Captains consent and parent or legal guardian if applicable.
All participants must sign an accident waiver before they will be allowed to ride, including parent or guardian if applicant is under 18.
All applicants must be able to promptly follow the verbal instructions of the host deputy, enter and exit the patrol car unassisted, and to take evasive action in an emergency.

All applicants must meet one or more of the criteria below (check all that apply) *

Resident of San Joaquin county
Visiting law enforcement personnel from other agency
Student of San Joaquin county high school and in possession of valid student body card
San Joaquin county employee and immediate family
Any valid news media representative
Current criminal justice program student (list academic institution)
Other (please specify)

Current criminal justice program academic institution

Other (please specify)

AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE WAIVER AND RELEASE OF CLAIM

The undersigned has requested permission to ride as a guest/observer in a San Joaquin Sheriff Department vehicle and accompany a member or members of the department during the active performance of their official duties as Deputy Sheriffs (initial) *

I, the undersigned, acknowledge that the work and activities of the department in connection with the ride-a-long are inherently dangerous to me, possibly involving risk of personal injury, death, damage, expense, or loss to person or property (initial) *

I, the undersigned, hereby releases the County of San Joaquin, the San Joaquin Sheriff's Office, its employess and/or agents, the driver or owner of any automobile owned or operated by or in the service of the County of San Joaquin, their sureties, and each of them, from liability or responsibility under any circumstances whatsoever, and by name by the undersigned, his or her estate or heirs, for any injury, death, damage, expense, or loss to the person or property of the undersigned, incurred while riding as a guest/observer in any vehicle, or while accompanying a member of said department during the active performance of his or her official duties as a peace officer (initial) *

I, the undersigned applicant declares under penalty of perjury that all of the information that I have given in the foregoing application is correct, and that I have read and understand the herein above agreement assuming risk of injury or damage, waiver and release of claims: and that I knowingly and willingly assume the risk of any loss, death, damageof any kind whatsoever, which I may incur as a result of participating in the "ride-a-long" program.

Applicant Signature *

Parent/Legal Guardian *

Emergency Contact *

Emergency Contact Phone *

Basic Information

PLEASE GIVE TWO WEEKS ADVANCE NOTICE FOR PROCESSING

Available Shifts:

Medical History

AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE WAIVER AND RELEASE OF CLAIM

Station & jail

Jail Information

NON-EMERGENCY

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