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Ride Along Online Request Form

  1. Voluntary Observer Information:
  2. Information which can be given to emergency personnel in case of emergency. Enter N/A if this does not apply.
  3. Please select the option which best describes you:*
  4. If you are currently attending a police academy, please list the name of the academy.
  5. 1st Emergency Contact:
    Only to be contacted in case of emergency.
  6. 2nd Emergency Contact Information:
    Only to be contacted in case of emergency.
  7. Waiver of Liability Agreement
    THE STATE OF TEXAS COUNTY OF FORT BEND KNOWN BY ALL MEN BY THESE PRESENTS: That I, the undersigned, as an inducement to the City of Rosenberg to allow me to participate in its ride-along and/or Career Outlook programs, and for and in consideration of the City of Rosenberg granting me the privilege to participate in the ride-along and/or Career Outlook programs, including riding as a guest and voluntary observe in a police patrol vehicle, and to accompany an officer or officers of the Rosenberg Police Department on patrol and in the exercise of their duties, and recognizing that police activity involves certain inherent dange4rs which may or could result in injury to me or my property, or even loss of like, which could be caused by many different events, including, but not limited to, motor vehicle accidents, vehicular pursuits, foot pursuits, apprehension of suspects, answering calls for assistance from citizens and other officers, and any other activity whether or not the type of activity in which officers customarily engage, acknowledge that I fully understand the consequences of my participation in the programs as herein delineated, and with full knowledge of the risks and hazards, all of which are known to me and reasonably anticipated, I do hereby assume any and all risks attendant to any incident, action, occurrence or activity occurring on public, private, or other property, which affect me in any manner whatsoever, and I do hereby release the City of Rosenberg , its officers agents, and employees, including, but not limited to, the Chief of Police of the City of Rosenberg and all officers, agents, or employees of the Police Department or other law enforcement departments acting in concert with the City of Rosenberg in both their public and private capacities, hereinafter referred to collectively as the “CITY”, from any and all liability, losses, damages, costs, claims, suits, demands or causes of action which I may have or later acquire by reason of any event, incident , accident, or occurrence which may occur during the time that I may be riding with or accompanying an officer or officers of the Rosenberg Police Department as a guest or voluntary observer, it being my intent that this release and hold harmless shall cover the resulting consequences of any event that may occur during the time of the activity as herein described whether or not the actual or potential loss or injury shall be then known or become known or evident at a later time. It is my intent that this release shall cover all liability, losses, damages, costs, claims, suits, or causes of action whether or no the same is the result of the negligence, acts or omissions of third parties, the City of Rosenberg, its officers, agents, and employees, including, but not limited to, the Chief of Police of the City of Rosenberg and all officers, agents, or employees of the Police Department or other law enforcement departments acting in concert with the City of Rosenberg in both their public and private capacities, or any other persons acting in concert with the City of Rosenberg from other jurisdictions, agencies, or law enforcement divisions of state or federal government. It is my intention that this release shall be a global release without exception or limitations, and nothing herein shall be deemed to limit, restrict, or otherwise provide limitations or exceptions on the releases herein stated. I further agree for myself, my heirs, executors, and assigns, to indemnify, hold and save harmless the CITY, its officers, agents, and employees, including, but not limited to, the Chief of Police of the City of Rosenberg and all officers, agents, or employees of the Police Department or other law enforcement departments acting in concert with the City of Rosenberg in both their public and private capacities, from any liability, action demands, suit, claim, loss, costs, damage, award or judgment, including all expenses of litigation, court costs and attorney’s fees, incurred or suffered by the CITY as a result of my presence, actions or omissions or caused by me while accompanying any employee, agent or officer of the City of Rosenberg Police Department, whether my involvement and causation is direct or indirect, for injury or death of any person, or for damage to any property. Such indemnity shall apply where the liability, losses, damages, costs, claims, suit, demands, action, award or judgment arise as a result of my own actions or the negligence of the CITY. It is further agreed that the execution of this release shall not constitute a waiver by the CITY of any defense or immunity of any nature whatsoever as provided for under applicable state or local law or any defenses that may be assertible under any applicable law or any right recognized by any court of law, administrative agency, or other entity. In addition, I make the following representations and acknowledgments upon which I intend the Rosenberg Police Department to rely: (1) I understand and agree that while accompanying any Rosenberg Police Officer, or another officer, agent or employee of the Rosenberg Police Department during his law enforcement rounds, I am to be only an unarmed lay observer and bystander with no active role whatsoever and that I will have and given no duties, rights, power or authority whatsoever other that those conferred by law upon any other person in like or similar circumstances as may arise from time to time and will under no circumstances interfere with the Rosenberg Police Department or offer any advice or counsel to any person being questioned, investigated, taken into custody or arrested by any Rosenberg Police Officer; (2) Neither will I be considered an agent, servant or employee of the Rosenberg Police Department, and, thus, I will not be covered by the Rosenberg Police Department for any workers’ compensation, death or disability benefits; (3) I realize that I may and will at unpredictable times be placed into both foreseeable and unforeseeable positions of considerable danger and agree that neither the Rosenberg Police Department 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 I hereby release them of any duty to do so intending hereby to willfully and voluntarily assume all risk inherent in any situation and under any circumstances that may arise incident hereto; (4) I agree that any information I may gain will be used only for my personal educational purposes except where I am summoned as a witness in any administrative or court proceeding; and (5) I certify that I am voluntarily choosing to participate in this program for personal and civic reasons without promise, expectation or receipt of monetary compensation. I certify that I have read the above and foregoing instrument, and I understand its terms and conditions and that I have sought appropriate legal, medical or other appropriate advice and counsel as I deem necessary so that I may fully understand the rights and obligations that I have waived or modified by this agreement as contained herein and that I execute this instrument voluntarily and that I am in sound mind and body and that I have not relied upon any representations made by the CITY or its employees or agents in signing this document, nor have any inducements been offered to me in the way of compensation or other inducements to obtain my signature hereon. I further certify that I am an adult over the age of eighteen (18) years in sound mental health and fully capable of understanding this agreement as herein provided.
  8. Electronic Signature Agreement*
    By checking the "I agree" box below, I certify that I have read the above and for going instrument and I understand its terms and conditions and I have sought appropriate legal, medical, or other appropriate advice and counsel as I deem necessary so that I may fully understand the rights and obligations that I have waived or modified by this agreement as contained herein and that I execute this instrument voluntarily and that I am in sound mind and body and that I have not relied upon any representations made by the CITY or its employees or agents in agreeing to this document, nor have any inducements been offered to me in the way of compensation or other inducement to obtain my agreement herein.
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