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2. INSTRUCTIONS: Read this form carefully and complete all sections applicable to the applicant. Pay particular attention to each rule. After reading and completing the form, electronically sign and submit the completed form. Print a copy of the completed form for your records.
6. Applicant's Name*
8. I, the above named applicant, wish to observe members of the Warner Robins Police Department perform their duties. This observation will include riding in police vehicles with members of the Warner Robins Police Department. These activities may include situations where I may suffer damage to my person or property.
10. I am freely and voluntarily requesting permission to participate in the Ride-Along Program. This program does not entitle me to, nor will I request, any compensation. I understand that permission to participate in this program may be revoked at any time.
12. For and in consideration of the undersigned being given the opportunity of observing police operations and functions of the Warner Robins Police Department and by all other means of observation whatsoever, the undersigned, in order to avail him/herself of said opportunity, recognizes and assumes any and all risks pertaining thereto, and hereby release the City of Warner Robins from any and all liability whatsoever for any injuries, damages, and claims the undersigned of the operations and functions of the Warner Robins Police Department.
14. If you want to ride with a SPECIFIC OFFICER please enter his/her name. Enter the date and time frame you want to ride.
16. Officer's Name
17. Requested Date
    Requested Date
18. Requested Time
    Requested Time Start Time

    —

    Requested Time End Time
20. I wish to participate in the Citizen Ride-Along Program because (be specific):*
24. CITIZEN RIDE-ALONG PROGRAM RULES
25. READ AND INITIAL EACH RULE
27. 1) Ride-Along passenger attire shall be business or business casual. Shorts, jeans, tank tops, and sandals are NOT PERMITTED. Attire including headgear, shall be free of slogans, phrases, advertising, etc. except for official government insignia.
28. Initial*
30. 2) Ride-Along passengers shall conduct themselves in a civil and professional manner and refrain from language or acts that are offensive to any person or person's race, color, creed, ethnic origin, gender, age, or physical or mental disability.
31. Initial*
33. 3) Ride-Along passengers shall be under the direct control of the police officer and will not interfere with officers while they are performing their duties.
34. Initial*
36. 4) Ride-Along passengers are authorized to observe only. Passengers shall not perform police related duties or acts unless directed to do so by a police officer. In an emergency, passengers may take appropriate action to protect themselves and/or officers.
37. Initial*
39. 5) Ride-Along passengers must be at least eighteen (18) years of age.
40. Initial*
42. 6) Ride-Along passengers must have never been convicted of, or are currently under investigation for, a felony offense by any law enforcement agency.
43. Initial*
45. 7) Ride-Along passengers mat not accompany an officer into a private residence without permission of the property owner or authorized representative, unless their presence is required to assist the officer.
46. Initial*
48. 8) Ride-Along passengers are not permitted to carry firearms while participating in a ride-along regardless of any license or permit issued to the passenger. Exceptions will be considered for certified and retired law enforcement officers who are current with all state and Federal mandated training and who have current certification and Peace Officer's Standards Training (POST) credentials in their possession.
49. Initial*
51. 9) Ride-Along passengers are not permitted to use any cameras, video, or audio recording devices while participating in a ride-along. Passengers shall silence all personal communication/wireless devices.
52. Initial*
54. 10) A patrol supervisor or participating officer may terminate the privileges of a ride-along passenger without explanation to the passenger.
55. Initial*
57. 11) This form must be submitted at least three (3) business days prior to the requested ride-along date and time.
58. Initial*
60. 12) Ride-Along passengers will not be impaired by alcohol or drugs when participating in a ride-along.
61. Initial*
63. Request for exception to rules 1-11 (explain in detail):
67. I have read, understand, and agree to abide with the agreement and rules pertaining to the Citizen Ride-Along Program.
69. Electronic Signature Agreement
    By typing my full name in the box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
71. Electronic Signature*
72. Date Of Birth*
73. Social Security Number*
75. Driver's License Number & State*
76. Race*
    -- Select One --American Indian / Alaska NativeAsianBlackNative Hawaiian / Pacific IslanderWhite
77. Sex*
    -- Select One --FemaleMale
79. Physical (Home) Address*
81. Phone Number*
82. Work Phone
83. Email Address*
87. The following section is for police administration use only
89. GCIC/NCIC Review

    1. Yes
    2. No
90. Supervisor Review

    1. Yes
    2. No
92. Ride-Along Program Supervisor comments:
94. Records Checked By:
95. No Record

    1. No Record
96. Record Attached

    1. Record Attached
98. Approved / Denied

    1. Approved
    2. Denied
99. Ride-Along Program Supervisor
100. Approved / Denied

     1. Approved
     2. Denied
101. Patrol Commander / Chief of Police
103. Notes:
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit Submit and Print

* indicates a required field