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1 Puyallup Police Department Ride Along Application ATTENTION Applicant MUST be 18 years old or older. (Applicants that are 16-17 years old may be approved for a ride along in certain circumstances with command staff approval). Applicant must live in, own a business in, or attend school in the city limits of Puyallup. Ride-Alongs will generally be for four hours. Unsponsored applicants are limited to one ride along unless approved by command staff. Date of Request: Full Legal Name: Date of Birth: Address: Phone: Employer or School: Phone: Medical Problems or Physical Disabilities: Check Appropriate Commissioned Officer City Employee City Resident CSO Dispatcher Police Department Job Applicant Media Student Job Shadow Family Member Other: Sponsoring Officer (if you have one): Requested Date to Ride: Emergency Contact: Phone: PROHIBITED CRIMES FOR RIDE ALONGS 1.Have you ever been arrested or convicted of any felony offense? Yes No (If you are unsure if a crime is a felony please list in space provided below and a determination will be made). 2. Have you ever been arrested or convicted in a misdemeanor crime? Yes No If yes please explain Print Form Submit by Email ---PAGE BREAK--- 2 Waiver and Guidelines for a Puyallup Police Ride Along The rider will obey all commands given by officers during the ride along. The rider will remain within the patrol vehicle unless otherwise instructed by the officer. The rider has read the Civilian Ride-Along program information sheet and understands and agrees to the information and restrictions placed on a civilian rider. The rider has been informed that if the officer is requested to respond to certain calls for service the rider may be let out prior to arrival at the call. The rider is responsible for his/her own transportation from the drop off location. The rider will not engage in any conversation with violators or prisoners other than general courtesies. The rider will not possess any audio or video recording equipment. The only exception is with prior approval from command staff. Riders will not post anything on any social media sites about their ride or what they observed during the ride. The rider will not possess weapons of any kind to include but not limited to knives, guns and chemical sprays unless they are a commissioned law enforcement officer. The rider will not enter any private residence with the officer they are riding with unless the officer first receives consent from the homeowner or person responsible for the residence at the time of the incident. The applicant does hereby request from the Puyallup Police Department to ride as an observer only in an authorized Puyallup Police Department vehicle. This observation is for the purpose of an educational benefit. The applicant fully realizes and appreciates the basic nature of law enforcement work and possibility that situations will arise which might place the applicant or expose the applicant to extreme danger. I recognize and accept all risks associated with being a passenger in a Puyallup Police vehicle during a ride along. I fully accept the risk of harm to myself including, but not limited to physical and mental injury and death. I hereby agree to release and hold harmless the City of Puyallup and its officials and employees from any cause of action, claim, or liability resulting from physical or mental injury or death that might occur during the ride along and I assume all such associated risk. The applicant may hear stories or see documents that may not be of public record. The purpose of the criminal history background check is to ensure the observer has not had any negative contacts with the police as well as has no criminal history. By submitting and signing this application, the applicant voluntarily and intelligently acknowledges and consents to the Puyallup Police Department conducting a criminal history background check that will include, but may not be limited to, arrest and conviction data. The information derived from the criminal history background check will be kept confidential to the extent permitted by law. I HAVE READ THIS WAIVER AND RELEASE OF LAIBILITY AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND I AM RELEASING SUBSTANTIAL RIGHTS BY SIGNING THIS WAIVER AND RELEASE OF LIABILITY. I VOLUNTARILY AND INTELLIGENTLY SIGN THIS WAIVER AND RELEASE OF LIABILITY AND CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE THRUTHFULLY AND ACCURATELY PROVIDED THE INFORMATION CONTAINED IN THIS APPLICATION. Signature: Date: Parent Name (If applicant under 18)(please print): Parent Signature: Date: *Please submit a copy of your driver's license with application. ---PAGE BREAK--- 3 Pre-Ride Screening Must be completed prior to ride-along Photo ID Copied and Attached No Record Background Completed Record Found and Attached Completed By: Date: Approved Denied (reason): By: Date and Time of Ride: Officer: Sergeant Notes: TO BE FILLED OUT BY POLICE DEPARTMENT PERSONNEL ONLY