Hold Harmless – City Of Florence

FLORENCE POLICE DEPARTMENT

RIDE ALONG PROGRAM

Hold Harmless Agreement

Rider Information

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First Name *

Middle Name *

Last Name *

Address *

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Date of Birth *

Phone Number *

Email *

Current Age *

Driver's License Number *

Social Security Number *

Please upload a copy of your Driver's License.

Click or drag a file to this area to upload.

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Preferred Shift *

Reason for Requesting to Ride *

Current Occupation *

Date you last rode with a City of Florence Police Officer

Instruction for Participants (Riders) in the Ride Along Program

Please read carefully and check each box to confirm that you have read & understood the following conditions. Your signature on this form indicates that you agree to abide by these conditions. *

1. All individuals accompanying officers of the City of Florence Police Department must be dressed in a presentable manner. The following attire is acceptable: casual business attire and appropriate shoes. The following items are NOT permitted: dresses, sleeveless shirts, or shorts. If a person is not dressed satisfactorily, the officer or their supervisor reserves the right to refuse or terminate the ride-along.
2. Person(s) riding is under the complete control of the officer at all times.
3. The rider shall not leave the police vehicle at the scene of any police activity or participate in any police activity unless directly requested by the officer.
4. Riders shall not converse with prisoners, suspects, victims, witnesses, or any other person contacted on police business unless requested by the officer.
5. Riders shall not interfere with the officer’s activities at any time. Although encouraged to ask questions regarding procedures and activities, it must be done at the appropriate time.
6. The shift supervisor will assign the rider to a “Host” officer for the Ride-Along.
7. The shift supervisor also may refuse the rider the opportunity to ride on any given day based on extenuating circumstances related to work conditions: shift shortage, weather conditions, etc.
8. Riders are allowed to ride three (3) times in a calendar year and not more than one (1) time during the same month. This requirement does not apply to the FPD Ranger Program, Interns, active police officers from other agencies/departments, police officer’s spouse (Spouses do not ride with their own spouse), or Chaplains.

Agreement

I do willingly participate in the City of Florence Police Department’s Ride-Along Program, in that I will be riding with City of Florence Police Officers, in City of Florence police vehicles while on regular patrol assignments. I do hereby agree, that while using the Florence Police Department’s facilities or while participating in the Florence Police Department’s Ride-Along Program, on or after this date, to hold harmless the Florence Police Department and the City of Florence, it’s agents and employees from any injury or damages sustained by me while using the Florence Police Department’s facilities or while riding in a City of Florence police vehicle. I also acknowledge that I assume responsibility for any accident or injury which may befall me while so engaged, and forever release the City of Florence, its Police Department, its agents and employees from any claim, whether it be based upon negligence, inadvertent or unforeseen incidents. I further represent that I understand all risks involved and agree that this HOLD HARMLESS AGREEMENT shall be binding upon my heirs, executors, administrators, and assigns.

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Rider’s Signature: *

Today's Date *

Welcome to Florence, Alabama

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Welcome to Florence, Alabama

FLORENCE POLICE DEPARTMENT

RIDE ALONG PROGRAM

Rider Information

Instruction for Participants (Riders) in the Ride Along Program

Agreement

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