Jacob Ortega - Ride Along Request [ACCEPTED - 01/FEB/2023]

[Jacob Ortega]

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Los Santos Fire Department
Ride-Along Application Format

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1. Personal Information:

• 1.1 First Name: Jacob
  1.2 Middle Name: Eduardo
  1.3 Last Name: Ortega

• 1.4 Address: 204 Bay City Avenue
  1.5 City: Los Santos
  1.6 State: San Andreas

• 1.7 Phone Number: 77436287
  1.8 Date Of Birth: 08/08/1997
  1.9 Gender:
  • [X] Male
    [-] Female
    [-] Other

• 1.10 Ethnic Group / Race (mark only one)
  • [-] Black
    [X] Hispanic
    [-] Asian/Pacific Islander
    [-] Caucasian
    [-] American Indian
    [-] Filipino
    [-] Middle Eastern

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2. Ride-Along Details

• 2.1 Type of a Ride-Along you're interested in:
  • [X] Field Ride-Along
    [-] Aerial Ride-Along
    [-] Both

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3. Personal Liability Waiver & Release Form

• 3.0 - Personal Liability Waiver & Release Form:

  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.

• 3.1 Full Name (Sign): Jacob Ortega
  3.2 Full Name (Print): Jacob Ortega
  3.3 DATE: 11/01/2023

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4. Legal Guardian / Parental Consent

• 4.0 To be filled out by a parent/legal guardian. Leave blank if you are over the age of 18.
  
  4.1 First Name:
  4.2 Last Name:
  4.3 Date of Birth:

• 4.4 Place of Residency-
  4.4.1 Address:
  4.4.2 City:
  4.4.3 State:

• 4.5 Relationship to Applicant
  • [-] Mother
    [-] Father
    [-]Other: (specify)

• 4.6 Do you, as a legal guardian / parent give consent for the applicant to take part in LSFD's Ride-Along program?
  • [-] Yes
    [-] No

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[Casey Harper]

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Dear Mr. Jacob Ortega,

After a thorough review of your ride-along application by one of our staff members, we are pleased to inform you that the application has been ACCEPTED.

Thank you for showing interest in the Los Santos Fire Department's Ride-Along Program. Pleasure ensure you are familiar with the guidelines and regulations. Your ride-along privileges will expire on 01/FEB/2023.

In order to attend a ride-along, you have the following options:

• Station 7 in El Burro Heights - Firefighter I+ or EMT
• Tower 1 in Vespucci Beach - Lifeguard+.

Best of luck!

Regards,
Administrator III, Casey Harper

[Casey Harper]

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Dear Mr.Jacob Ortega,

Your ride-along authorization has now EXPIRED. In order to become eligible for further sessions, you must re-apply and obtain approval once more.

Thank you for showing interest in the Los Santos Fire Department Ride-Along Program.

Regards,
[Administrator III, Casey Harper]