
Ride Along Program Information
Application Format
Code: Select all
Firstname Lastname - Ride Along Request
Code: Select all
[divbox=white]
[img]https://i.imgur.com/BciMx9h.png[/img]
[center][b][size=130]Los Santos Fire Department[/size][/b]
[b]Ride Along Application Format[/b][/center]
[hr][/hr]
[size=110][b]1. Personal Information:[/b][/size]
[list=none]
[b]1.1[/b] First Name:
[b]1.2[/b] Middle Name:
[b]1.3[/b] Last Name:
[/list]
[list=none]
[b]1.4[/b] Address:
[b]1.5[/b] City:
[b]1.6[/b] State:
[/list]
[list=none]
[b]1.7[/b] Phone Number:
[b]1.8[/b] Date Of Birth: DD/MMM/YYYY
[b]1.9[/b] Gender:
[list=none]
[-] Male
[-] Female
[-] Other
[/list]
[/list]
[list=none]
[b]1.10[/b] Ethnic Group / Race ([u]mark only one[/u])
[list=none]
[-] Black
[-] Hispanic
[-] Asian/Pacific Islander
[-] Caucasian
[-] American Indian
[-] Filipino
[-] Middle Eastern[/list][/list]
[hr][/hr]
[size=110][b]2. Ride Along Details[/b][/size]
[list=none]
[b]2.1 Type of a Ride Along you're interested in:[/b]
[list=none]
[-] Field Ride Along
[-] Aerial Ride Along
[-] Both
[/list]
[/list]
[list=none]
[b]2.2[/b] What is the reasoning behind your ride along?:
[b]2.3[/b] Are you interested in joining the LSFD?:
[b]2.4[/b] Do you have any previous ride along experience?:
[/list]
[hr][/hr]
[size=110][b]3. Personal Liability Waiver & Release Form[/b][/size]
[list=none]
[b]3.0 - Personal Liability Waiver & Release Form:[/b]
[quote]As a condition precedent to being permitted to ride as a Ride-Along with the Los Santos Fire Department, I the undersigned, waive any claim I may have against the Los Santos Fire Department for any loss of life, bodily injury, property damage or any other claim whatsoever that I may sustain as a result of my Ride Along. I further agree that this waiver of liability by me is binding on my legal representatives, heirs, and successors, and shall have the same legal effect as I have agreed to herein. I also understand that the Los Santos Fire Department may waive my right to a Ride Along for any reason and at any time, especially should I be in violation of the regulations set. Having that said, I adhere to the regulations set by the Los Santos Fire Department.[/quote]
[/list]
[list=none]
[b]3.1[/b] Full Name (Sign):
[b]3.2[/b] Full Name (Print): [u]NAME HERE[/u]
[b]3.3[/b] DATE: DD/MMM/YYYY
[/list]
[hr][/hr]
[size=110][b]4. Legal Guardian / Parental Consent[/b][/size]
[list=none]
[b]4.0[/b] To be filled out by a parent/legal guardian. Leave blank if you are over the age of 18.
[b]4.1[/b] First Name:
[b]4.2[/b] Last Name:
[b]4.3[/b] Date of Birth:
[/list]
[list=none]
[b]4.4[/b] Place of Residency-
[b]4.4.1[/b] Address:
[b]4.4.2[/b] City:
[b]4.4.3[/b] State:
[/list]
[list=none]
[b]4.5[/b] Relationship to Applicant
[list=none]
[-] Mother
[-] Father
[-]Other: (specify)
[/list][/list]
[list=none][b]4.6[/b] Do you, as a legal guardian / parent give consent for the applicant to take part in LSFD's Ride Along program?
[list=none]
[-] Yes
[-] No
[/list][/list]
[/divbox]