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Enter Driver's License. Do not enter Social Security Number. If that is your identification, enter "SSN" in field, and print it on the form when you print it out to sign.
The following information is requested for emergency purposes only.
List any medical problems for which rider is being treated or past medical problems of which the City should be aware.
List two people who can be notified in case of an emergency.
A. The City is willing to allow the Rider/Observer the opportunity to accompany and ride with a police officer(s) in a police vehicle or fire fighter(s) in a fire vehicle, while in the performance of their duties, for the purpose of observation, said opportunity hereinafter referred to as “ride along.”
B. The City is willing to allow the Observer the opportunity to sit-in the Dispatch or Records Section to observe dispatchers/records personnel in the performance of their duties, for the purpose of observation, hereinafter referred to as “sit-in”.
C. The Rider understands and appreciates that there are known and unknown risks which the Rider will be exposed to in a ride along, and Rider does not wish to hold the City of Grants Pass, or any of its officers, employees, agents, or representatives responsible in either a Municipal or personal capacity for any injury, death, disability, or damages to property that may occur as a result of the ride along, regardless of who may be at fault. Rider knows that the risks are too numerous to mention herein, but include without limitation, such things as traffic accidents, the discharge of firearms, fights, brawls, altercations, riots, fire calls, rescue calls, medical calls, hazardous material calls.
D. The observer understands that while observing they will see and hear information that is confidential in nature, including information on a computer terminal. Disclosure of any information can result in criminal and civil charges being filed against the observer and can result in civil liability for the public safety agency involved. Therefore, in order to protect the confidentiality of the information and to protect the integrity of agreements which the Grants Pass Department of Public Safety has with local, state, and federal agencies the observer agrees that any and all information that they see, hear or discuss while participating in the observation period will not be repeated to anyone without written permission of the Grants Pass Department of Public Safety Director.
NOW, THEREFORE, in consideration of the above and of the mutual covenants contained herein:
For safety reasons, the passenger side air bags on patrol cars equipped with Mobile Data Terminals (MDT) have been disabled. As a result, in the event of a front end collision, there will be no air bag deployment on the passenger side of the vehicle.
Witness to signature of Rider/Observer, and witness to signature of parent or guardian if Rider/Observer is under 18 years of age:
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