SANTA ROSA POLICE DEPARTMENT APPLICATION FOR "RIDE-ALONG" PROGRAM

Transcription

1 Date of application: SANTA ROSA POLICE DEPARTMENT APPLICATION FOR "RIDE-ALONG" PROGRAM Ride-Along Observers must be 16 years of age or older AND must reside within the jurisdictional limits of the City of Santa Rosa. (Residency requirement may be waived by a sergeant or watch commander.) Observers will be required to read and sign the Waiver of Liability and the Instructions for Observers forms. Observers under the age of 18 years will be required to have the signature of a parent or legal guardian on the Waiver of Liability form. The signature of all applicants, including the signature of parents of juvenile applicants shall be witnessed by Police Department personnel. Ride-Alongs are normally conducted between 7:00 a.m. and 1:00 a.m., seven days a week. All observers must have authorization of the on-duty supervisor or the program coordinator. Authorization for any exception shall only be made by the on-duty supervisor or a watch commander. Participating in a ride-along with the Santa Rosa Police Department is limited to once during the calendar year. Due to the volume of requests received by the Police Department, applicants should not expect to be contacted regarding approval or denial until at least fourteen (14) days after application submission. NAME (PRINT) AGE: ADDRESS: DRIVER S LICENSE NUMBER: BIRTHDATE: / / PHONE NO. DAY: EVENING: ADDRESS: REASON FOR INTEREST IN "RIDE-ALONG" PROGRAM: Requested date and time: APPROVED DENIED BY: OFFICER ASSIGNED: BADGE: RIDE-ALONG COMPLETION DATE: [DEPARTMENT USE ONLY] ***NO CAMERA OR RECORDING EQUIPMENT PERMITTED*** Your application for participation in the Santa Rosa Police Department's "Ride-Along" Program has been approved. Please report to the front counter of the Santa Rosa Police Department, 965 Sonoma Avenue, Santa Rosa, at: A.M./P.M., on. Your application has been denied because: PROGRAM COORDINATOR: DATE: SRPD 275 (Rev 3/2013)

2 EXPRESS ASSUMPTION OF RISK OF PERSONAL INJURY, DEATH, OR DAMAGE; WAIVER AND RELEASE OF CLAIMS AND INDEMNITY AGREEMENT [CITY OF SANTA ROSA - POLICE DEPARTMENT RIDE-ALONG PROGRAM] I,, am (under/over) the age of 18, and not a member of the Santa Rosa Police Department. I have requested authorization to ride as an observer in a vehicle operated by the City of Santa Rosa Police Department by and through an officer or member of the Police Department during the performance of his/her official duties. The City of Santa Rosa, through its Police Department, agrees to permit me to ride as an observer in a vehicle assigned to that department and to accompany an officer or member of the department during the performance of his/her duties, upon the following conditions: 1. That I am aware that the work of the Police Department is inherently unpredictable, dangerous, and hazardous and that I may be subject to the risk of personal injury, death, or damage to my property by accompanying an officer or member of the Police Department during the performance of his/her official duties. I freely, voluntarily and knowingly assume the risk of death, personal injury or property damage sustained by me in any way whatsoever, whether foreseeable or unforeseeable, while accompanying an officer or member of the Police Department during the performance of his/her official duties; 2. In consideration for the authorization granted by the Santa Rosa Police Department permitting me to accompany an officer or member of the Police Department during the performance of his/her official duties, I hereby waive, release, and discharge any and all claims for damages for death, personal injury or property damage which I may have, or which may be asserted hereafter by my estate as a result of my accompanying an officer or member of the Police Department during the performance of his/her official duties. This waiver and release is intended to discharge in advance the City of Santa Rosa, it officers, agents, employees, volunteers, and any other involved public entity, and their respective officers, agents, employees, and volunteers, from and against any and all liability arising out of or connected in any way with my accompanying an officer or members of the Police Department during the performance of his/her official duties, even though that liability may arise out of the negligence, whether active or passive, or carelessness or omission of the City of Santa Rosa, the Santa Rosa Police Department, any other involved municipality or public entity or their respective officers, agents, employees, volunteers, or otherwise; 3. That I, or my heirs, executors, administrators and assigns, will defend and indemnify the City of Santa Rosa, its officers, agents, employees, volunteers, and each of them, against any and all manner of actions, causes of actions, suits, debts, claims, demands or damages or liability or expense of every kind and nature (including attorney's fees) incurred or arising by reason of any actual or claimed negligent or wrongful act or omission, whether active or passive, of mine while accompanying an officer or member of the Police Department during the performance of his/her official duties. SRPD 276 (Rev 3/2013)

3 EXPRESS ASSUMPTION OF RISK OF PERSONAL INJURY, DEATH, OR DAMAGE; WAIVER AND RELEASE OF CLAIMS AND INDEMNITY AGREEMENT [CITY OF SANTA ROSA - POLICE DEPARTMENT RIDE-ALONG PROGRAM] (CONTINUED) 4. I further agree to reimburse the Police Department and the City of Santa Rosa for any personal property damaged or destroyed by me, whether negligently or intentionally, while accompanying a member of the Police Department during the "Ride-Along". I have read this form and understand it completely. To get the authorization I seek, I voluntarily agree to all the above-mentioned conditions. DATE SIGNATURE of ADULT APPLICANT DATE SIGNATURE OR PARENT/LEGAL GUARDIAN POLICE DEPARTMENT WITNESS: SRPD 276 (Rev 3/2013)

4 SANTA ROSA POLICE DEPARTMENT RIDE-ALONG PROGRAM Instructions for Observers 1. Observers will be under the direction of a police officer at all times. If a dangerous or emergency situation arises, the officer may direct observers to take appropriate actions to ensure their safety. Observers shall follow the directions of the officer. The officer may at any time dismiss an observer if he/she believes the observer's presence or conduct would be a danger to the observer or citizenry or interfere with the proper performance of the officer s duties. 2. Observers will remain in the police car at the scene of police activities unless otherwise instructed by the police officer. 3. Observers shall not participate in police activity unless specifically requested by the police officer or the officer's immediate supervisor. 4. Observers shall not engage in any conversation with prisoners, suspects, witnesses or any other parties contacted by police officers in the course of business unless requested by the police officer. 5. Observers shall not interfere verbally or physically at any time during the officer's activities. 6. All observers shall arrive at the Police Department 15 minutes prior to the assigned time. If an observer is unable to keep his/her appointment, he/she should notify the Police Department Ride-Along Coordinator as soon as possible. 7. The acceptable dress code for ride-alongs shall be as follows: casual business attire consisting of collared shirts or blouse; long pants (no jeans) or skirt; jacket/coat if appropriate. No shorts, sandals, sweats, or t-shirts. Audio/video recorders and/or cameras are prohibited. Observers shall not have in their possession any object or object(s) that might be considered a weapon. 8. All observers are required to sign the Waiver of Liability form in the presence of the officer conducting the ride-along. 9. Observers shall keep confidential the name and identity of any individual contacted or investigated during the ride-along. 10. The Watch Commander or Patrol Team Supervisor has authority to deny ride-along participation at any time. I HAVE READ EACH OF THE ABOVE INSTRUCTIONS, UNDERSTAND THEM, AND AGREE TO FOLLOW THEM. Observer: Witness: (Police Department Personnel) Parent/Guardian: DEPARTMENT USE ONLY: (If observer is under 18 years of age) Date: ILEADS CDL Warrants SRPD 277 (Rev 3/2013)

5 OFFICER S NOTES Officers conducting ride-alongs may use this area to note an observer s conduct, if necessary. Observer Name: Officer Name: Ride-Along Date: Duration of Ride-Along: Notes: