Basic Information
Date of Birth
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Phone
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Email
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Driver's License Number
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Why do you want to participate in this program?
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Past Ride A Long Participation Date
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If "Yes" explain:
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PLEASE GIVE TWO WEEKS ADVANCE NOTICE FOR PROCESSING
Shift Preference
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Days 0600-1600 Days 0800-1800 Swing 1500-0100 Graves 2100-0700
Date Preference
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Medical History
Current criminal justice program academic institution
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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)
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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)
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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)
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Emergency Contact Phone
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If you are human, leave this field blank.
