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Ride Along Request Form

  1. Instructions

    Please complete the following fields. Once your form has been received a criminal background check will be completed. You will then be contacted to set up your ride along.

  2. MM/DD/YY

  3. Provide an emergency contact. If under 18 provide your parent/guardian name.

  4. Ride Along Scheduling

    Upon receipt of this form a criminal records check will be conducted. Once approved, you will be contacted via telephone to set-up your ride-along date. Please keep in mind this process may take 5-10 business days when selecting your preferred dates.

  5. Agreement & Waiver

    CITY OF FITCHBURG POLICE DEPARTMENT

    AGREEMENT ASSUMING RISK OF INJURY OR DAMAGE, WAIVER AND RELEASE OF CLAIMS AN INDEMNITY AGREEMENT

    WHEREAS, I,___________________________________________________, (being/not being) over the age of eighteen and not being a member of the City of Fitchburg Police Department have made a voluntary request to ride as a guest in a vehicle assigned to the City of Fitchburg Police Department during the performance of their official duties, and


    WHEREAS, the City of Fitchburg Police Department is willing to allow me to ride as a guest in a vehicle assigned to that department and to accompany a member or members of the department during the performance of their duties on the following conditions:


    NOW, THEREFORE, in consideration of the permission given to me to ride in a vehicle assigned to the City of Fitchburg Police Department and to accompany a member or members of said department during the performance of their official duties, I do hereby agree:


    1. That I shall be under the immediate and direct control of the officer to whom I have been assigned and will obey that officer’s directions at all times; that I will not engage in any police activity unless expressly directed to do so by an officer; that I will not be armed with any manner of weapon unless I am a sworn police officer in the State of Wisconsin, in which case I may carry a concealed firearm in conformity with Wisconsin Statutes and my department’s policy; that I will be identified upon request as an observer and in no way will be identified as having any police power; and, that if at any time the responsible officer or the officer in charge determines that it is appropriate to terminate my participation, I will immediately comply.


    2. That I am aware that the work of the City of Fitchburg Police Department is inherently dangerous and that I may suffer death, personal injury or damage to my property by accompanying member or members of the City of Fitchburg Police Department during the performance of their official duties and that I freely, voluntarily and with such knowledge assume the risk of death, personal injury, or property damage arising from or in any way connected with the use of weapons, unlawful acts of forcible resistance by law violators or suspected law violators, assault, riot, breach of the peace, fire explosion, electrocution or the escape of radioactive substances while accompanying a member or members of the City of Fitchburg Police Department during the performance of their official duties.


    3. That the City of Fitchburg, its officers, officials, employees and agents, the Police Chief for the City of Fitchburg, his sureties, all members of the City of Fitchburg Police Department and/or the Fitchburg Police and Fire Commission, their sureties, and each of them, shall not be responsible or liable for any injury, damage, loss or expense, either to me or my property, incurred while participating as a citizen observer in the City of Fitchburg Police Department Ride-Along Program, including while riding in or occupying any vehicle assigned to the City of Fitchburg Police Department, while accompanying any member or members of said department during the performance of their official duties, or while performing any act requested of me by a member or members of said department, and resulting from any negligent act or omission on the part of any member of the City of Fitchburg Police Department or the City of Fitchburg.


    4. For myself, my heirs, executors, administrators and assigns to hold harmless defend and indemnity the City of Fitchburg, its officers officials, employees and agents, Police Chief of the City of Fitchburg, all members of the City of Fitchburg Police Department and/or the Fitchburg Police and Fire Commission, their sureties, and each of them, against any and all manner of actions, causes of actions, suits, debts, claims, or damages or liability or expense of every kind and nature incurred or arising by reason of any actual or claimed negligent, intentional or wrongful act or omission of mine while participating as a citizen observer in the City of Fitchburg Police Department Ride-Along Program, including while riding in or occupying any vehicle assigned to the City of Fitchburg Police Department, while accompanying any member or members of said department during the performance of their official duties, or while performing any act requested of me by a member or members of said department.

  6. Acknowledgement*

  7. By typing your full name in this field you hereby acknowledge the above agreement and agree to all terms and specified conditions.

  8. By typing your full name in this field you acknowledge serving as a witness (or parent/guardian) of the above listed person having electronically signed this form.

  9. Leave This Blank:

  10. This field is not part of the form submission.