Section 1 of 4 in this document
Ride-Along Application
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Receipt
You will be provided with a Receipt upon submission.
Have you read the Program Guidelines and do you fully understand their content?
No
Yes
Program Guidelines (holder)
Section 2 of 4 in this document
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Applicant Information
Applicant Full Name
First Name
*
Initial
Last Name
*
Applicant Address
Street Address
*
City
*
State
*
Zip
*
Date of Birth
*
Driver's License Number
Driver's License State
Applicant Phone
Applicant Email
Is the applicant under the age of 18?
No
Yes
Are you currently taking any medications and/or currently under a doctor's care?
No
Yes
Please explain if the above questions was "Yes"
*
What created your interest in a Ride-Along with our department?
*
Section 3 of 4 in this document
Applicant's driver's license or birth certicate
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Waiver: I understand that by signing below I waive any right and/or cause of action I may have against the City of Hyattsville, and/or the City of Hyattsville Police Department, arising from my participation in the Ride-Along Program. In addition, acknowledge and understand that information provided on this application will be used to check for a criminal history record for the purpose of ensuring the safety of all persons concerned. I understand that a criminal history is grounds for denial of my application. I further understand that the police department is prohibited from disclosing any information resulting from this check.
Parental Consent/Waiver (Juvenile Applicants Only): I do hereby grant permission for my child to participate in the City of Hyattsville Police Department's Ride-Along program and recognize that my child will be accompanying a police officer on patrol. I acknowledge that I have read and understand the program's guidelines and waive any right and/or cause of action that I or my child may have against the City of Hyattsville, and/or the City of Hyattsville Police Department, arising from my child's participation in the Ride-Along program. In addition, acknowledge and understand that information provided on this application will be used to check for a criminal history record for the purpose of ensuring the safety of all persons concerned. I understand that a criminal history is grounds for denial of this application. I further understand that the police department is prohibited from disclosing any information resulting from this check.
Signature (Applicant if 18 or older, Guardian if under 18)
Signature (Applicant if 18 or older, Guardian if under 18)
First Name
Last Name
Email
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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
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