Ride Along Application Form/liability Waiver And Claims Release - Newport Police Department Assumption Of Risk Page 2
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2NEWPORT POLICE DEPARTMENT
RIDE ALONG APPLICATION
I, (print name)
, hereby make a voluntary request to
ride as a guest in a vehicle operated by the Newport Police Department, and to accompany a police
officer employed by the City of Newport during the performance of official duties.
I represent to the City of Newport Police Department that:
● I am age 15 or older.
● I am not suffering from any illness or physical impairment, except the following:
____________________________________________________________
____________________________________________________________
● I have/have not (
been on a previous ride along with the Newport Police.
)
circle one
● I am not currently under the influence of alcohol, narcotics or any illicit drug, and
will not be at the time of the ride along.
● I will be suitably dressed in collared shirt, blouse, or jacket, slacks, and shoes. I
will not wear sandals, t-shirt, tank top, shorts, or ripped or torn blue jeans, nor will
I wear a hat or ball cap in the police vehicle. My host officer may refuse a ride-
along if I am not properly dressed, per NPD policy.
Date of Birth: __________ Social Security #: _________________ ID/ODL #_______________
Current Address: ________________________________________________
City, State
________________________________________________
Telephone:
_______________________ Email: ________________________________
Reason for Ride Along Request:
To observe how the department operates
To learn about the activities and parameters of the Law Enforcement profession
To gain a better understanding of the interaction of the department with the community
To gain a better understanding of the judicial system and how Law Enforcement works
within the system
Assist with school or college projects
Other (Describe)_________________________________________________________
Date that I wish to ride: _____________I wish to ride with: _____________________________
Date/Time
Officer
Approved:
Yes No by:_____________________________Approval Date:_____________
If denied state reason__________________________________________________________
Scheduled by Sgt.:__________________________________Date:______________________
Assigned to:__________________________by Sgt.:__________________Date:___________
Actual Date of Ride Along:______________ Hours of Ride Along:__________to__________
When completed, please return this form to the Chief’s Assistant. Thank you.
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