Irving Police Department
Date Request to Ride and Waiver of Liability
Last Name First Name Middle Name Date of Birth
Street Address City State Zip
Race Sex Social Security Number DL State DL Number
Home Phone Business Phone E-Mail 6:00 AM 7:00 AM 6:00 PM 7:00 PM Date Requested to Ride Time Requested to Start (Please Circle One) Officer Preference (Name) Yes No Have You Ridden Before? If So, When? Have You Been Denied? # of Times Ridden in Past 12 Months Notice to Non-Police Riders: Any person with a felony conviction will not be permitted to ride. Those with misdemeanor convictions will be considered on a case by case basis. However, a conviction for an offense against an officer or public official will disqualify the requestor from riding. All riders must be properly groomed and attired. Male observers should wear slacks and a dress shirt, but are encouraged to wear a tie and jacket. Female observers should wear suitable business attire. Rules of Conduct: The staff of the Irving Police Department welcomes your participation as an observer in our Civilian / Rider Observation Program. You should be aware that the nature of police duty is sometimes dangerous and at times involves tense situations. In the interest of effective police operations and your own safety, you will comply with the following regulations and will not: 1. Use alcoholic beverages prior to or during the observation ride. 2. Use profane or abusive language. 3. Make remarks or voice opinions to complainants, witnesses, victims, violators, or suspects in any manner which would tend to provoke, degrade, or escalate tensions. 4. Give information to any unauthorized person that may compromise a police operation, procedure, or investigation in progress or anticipated. 5. Give information to unauthorized persons concerning the identity of arrested persons, persons confined in jail or suspects in a criminal act. 6. Use any learned information for personal gain. 7. Carry a firearm or convey or state to anyone that you are a police officer unless you are a certified Texas Peace Officer.
Signature Civilian / Rider Observation Program Waiver of Liability
In consideration for the Irving Police Department allowing me to participate in its Civilian / Rider Observation Program, I, , hereby waive all claims for damage or loss to my person or property which may be caused directly or indirectly by an act or omission of the City of Irving, including the Irving Police Department, its officers, supervisors, agents, or employees. I expressly assume the risk of all dangerous conditions or occurrences which may be encountered while participating in the Irving Police Department Civilian / Rider Observation Program. I further waive any and all specific notice of the existence of any such conditions or occurrences.
I further release, hold harmless, and forever discharge the City of Irving, including the Irving Police Department, its officers, supervisors, agents, and employees, for any and all liability, claims, expenses, including attorney's fees and cost of court, actions or causes of actions whether real or asserted of every nature, kind and character whatsoever arising out of said accompaniment, and do covenant not to sue.
I have read this form and I understand the contents.
Signature Date Printed Name
Parent of Guardian Date Printed Name
Parent of Guardian Date Printed Name
Department Use Only
Attach 10/29 and CCH Ride Approved By:
Date: Beat: Watch: Officer:
Comments: