Ride Along Request

2. First Name*
3. Middle Initial
4. Last Name*
6. Street Address*
8. City*
9. State*
10. Zip*
12. Date of Birth*
13. Race
14. Sex
16. Phone*
17. Email
19. Occupation
21. Emergency Contact*
22. Emergency Contact Phone*
24. Please check the following that apply to you

    1. I am 18+ years old and am requesting this Ride Along as a citizen looking to observe day-to-day duties of a patrol officer.
    2. I am 18+ years old and am interested in applying to be a West Lake Hills Police Officer.
    3. I am 18+ years old and am requesting this Ride Along for reasons other than those mentioned above.
26. Reason for requesting a Ride Along with WLHPD*
28. Please provide at least two dates you are available*
    Please provide at least two dates you are available
29. Date Option 2*
    Date Option 2
31. Time Request*

    1. 6 a.m. - 6 p.m.
    2. 6 p.m. - 6 a.m.
    3. Other
32. Other Time Requested
34. Specific Officer Requested
36. Officer Name
37. Relationship
39. WAIVER OF LIABILITY

    I, the undersigned, a private person, for and in consideration of the privilege of riding as a guest and voluntary observer in a police patrol vehicle of the City of West Lake Hills, do hereby authorize a review and full disclosure of all records concerning myself to any duly authorized agent of the West Lake Hills Police Department, whether the said records are public, private, or confidential in nature. I recognize that routine police activity involves certain inherent dangers. I hereby agree, binding my heirs, executors, administrators and assigns to forfeit, release and agree not to hold liable, the city of West Lake Hills, its officers, agents and employees from any and all action, claims, demands, costs or damages arising from or resulting from property damage, personal injuries or death sustained by me or my property while participating as a ride along police observer.

    This includes, but is not limited to, motor vehicle accidents on either public streets or private property, any personal injury or property damage resulting from the acts of a third person, or any personal injury or property damage arising from the acts of the City of West Lake Hills, its Police Department, agents, and employees, in both their public and private capacities, from any and all liability, claims, suits, demands or causes of action for both personal injury or property damages, including any wrongful death claims pursuant to the TEX. CIV.PRAC. & REM.CODE ANN. Ch 71 et. seq. (Vernon 1986), the survival cause of action pursuant to Tex. CIV. PRAC. & REM. CODE ANN. Sec 71.021 (Vernon 1986), that may arise from riding as a voluntary observer on a routine police patrol, or any personal injury or property claims resulting from the negligent acts of the City of West Lake Hills, the West Lake Hills Police Department, its agents and employees.

    It is further agreed that the executions of this release shall not constitute a waiver by the City of West Lake Hills, of the defense of governmental immunity, where applicable, or to defenses predicated on the Texas Automobile Guest Statute, TEX. CIV. PRAC. & REM. CODE ANN. Ch. 72 (Vernon 1986), or any other defense recognized by the Courts of this State. I further agree, binding my heirs, executors, administrators and assigns to indemnify, hold and save harmless the City of West Lake Hills, its officers, agents, and employees from any liability, action claim, damage, award or judgement incurred or suffered by the above City or individuals as a result of any act or omission by me or caused in whole or in part by me while participating as a ride along police observer whether or not also caused in part by a person indemnified hereunder. In addition, I make the following representations and acknowledgements upon which I intend the City to rely:

    1. I understand and agree that while accompanying any police officer during his/her law enforcement rounds, I am to be only an unarmed, lay observer and bystander with no active role whatsoever and that I will not have, nor will I be given any duties, rights, powers or authority whatsoever other than those conferred by law upon any other person in like or similar circumstances as may arise from time to time.

    2. I understand a warrant and criminal history check are done on all requestors prior to approval being given.

    3. I understand that I will be required to dress neatly and conservatively – shirts must have a collar and long pants are required. No shorts are allowed, close toed shoes are required – no sandals or flip flops. Clothing with offensive wording, political affiliations, or clothing not meeting the above standards will result in rider being sent home and ride-along cancelled.

    4. I realize and agree that while participating as a ride along police observer, I will not be an agent, servant, or employee of the City of West Lake Hills and therefore will not be covered by the city for any workman's compensation, death or disability benefits.

    5. I realize that as an inherent part of riding along as a police observer, I will at unpredictable times be placed in both foreseeable and unforeseeable positions of considerable danger and agree that neither the city nor any of its officers or employees shall be obligated to take any steps or action to protect my person or provide a means of withdrawal or retreat for me, and release them of any duty to do so.

    6. I agree that any information I may gain, through participation as a ride along police observer, will be used by me only for my personal education, except where I am summoned as a witness in any court or administrative proceeding, and I will not publish or release any information gained while participating as a ride along police observer without expressed written permission from the Chief of Police.

    7. I understand and agree that I will not be allowed to take any photographs, video, or audio recordings using any device whatsoever at any time during the ride along.

    8. I understand that my participation as a ride along police observer is a privilege subject to revocation at any time by the City of West Lake Hills. 

    By signing this release, I am representing to the West Lake Hills Police Department and the City of West Lake Hills, its agents and employees, that I am of sound mind and that I have read this waiver and understand fully the terms expressed herein and voluntarily agree to said terms.

41. Signature*
42. Date*
46. FOR OFFICE USE ONLY

    First: ____________________________ MI: ______ Last: ____________________________

    Date of Birth: _____________________________ DL#: _____________________________

    Address (City/State/Zip): _____________________________________________________________________________

    Signature: _________________________________________ Date: ______________________

    
    

    Subscribed and sworn to before me, by the said _______________________________________________________________________

    This ____________ day of ____________________, 20 ____________ to certify which witness my hand and seal of office.

    __________________________________________________________________

    Notary Public in and for ________________________ County, Texas

    My Commission expires: _______________________________________

    
    

    
    

                                                      Seal

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field