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Home My WebLink About106.140 - FD-78, Ride-Along Participant Application ADMINISTRATIVE MANUAL FORMS 106.140 RIDE-ALONG PARTICIPANT APPLICATION (FD-78) EFFECTIVE: SEPTEMBER 2010 Current Revision Date: 8/28/19 Next Revision Date: 8/28/22 Author’s Name/Rank: Timothy J. Fulmer, Administrative Battalion Chief Review Level: 1 Administrative Support: Sherrie L. Badertscher, Management Analyst II PURPOSE Form used to request, schedule, and release liability of ride-along applicants. APPLICATION Civilians requesting to participate in the Fresno Fire Department’s (FFD or Department) Ride-Along Program must complete the Ride-Along Participant Application, Form FD-78. This form provides the Department with pertinent information for background checks, emergency contact information, and a Declaration of Assumption of Risk and Release of Liability section. OPERATIONAL POLICY This section intentionally left blank. OPERATIONAL GUIDELINE Copies of the FD-78 should be maintained at headquarters and all fire stations. The applicant must complete both sections of the form. The form should be routed to the Fire Investigation Unit Supervisor, who will conduct a background check and schedule an interview (in person or via telephone). Once approved for the ride- along, the form will be routed to the Department’s Fire Prevention Division at fire headquarters for processing. Information regarding short-notice ride-alongs can be found in Administrative Manual, Section 113.002, Ride-Along Program. Section 106.140 Page 1 of 4 PROCESS Applicants completing the FD-78 must print their name at the top of the Declaration of Assumption of Risk and Release of Liability section. Applicants must indicate their age, the date, and sign the bottom of the form. If requesting applicants are minors, their parent or legal guardian must also sign the bottom portion. The form is forwarded to the Fire Investigation Unit Supervisor for approval. Once approved the form is sent to Fire Prevention Division support staff and to the assigned field battalion chief. When a Department member’s family member, a member of another public safety, or military agency requests to ride-along on short notice and a background investigation and interview is not possible, the on-duty battalion chief may sign and approve the request after confirming the accuracy of the Ride-Along Participant Application. Short notice ride-along applicants must complete a FD-78 form. INFORMATION This section intentionally left blank. DEFINITIONS This section intentionally left blank. CROSS-REFERENCES Administrative Manual Section 113.002, Ride-Along Program Section 106.140 Page 2 of 4 FD-78 DECLARATION OF ASSUMPTION OF RISK AND RELEASE OF LIABILITY (Read this document in full before signing) I, ____________________________________, the undersigned, declare the following: I am __________ years of age, and not a member of the Fresno Fire Department. I have made a voluntary request to participate in the Ride-Along Program of the Fire Department. During this time, I understand I will accompany any member of the Fire Department to whom I may be assigned during the performance of his/her official duties. These duties may include riding with said officer in a Fire Department vehicle and being present at the scene of a fire or other emergency. I understand the Fire Department will allow me to participate in the Ride-Along Program only upon my agreement of the following conditions: that I assume the risks involved in said participation and that I release and hold harmless the City of Fresno, its officers, agents, and employees from all liability. I understand the duties of the members of the Fire Department are inherently dangerous. I also understand I may be subjected to the risk of death or personal injury or of damage to my property during my participation in the Ride-Along Program. I further understand said risks may arise from, but may not be limited to the following: civil disturbances; explosions; electrocution, the escape of radioactive substances; the effects of wind, rain, fire, and gas; vehicular collision; and air or blood-borne pathogens. I freely and voluntarily assume all of said inherent risks, whether or not they are listed herein. In consideration of my being permitted to participate in the Ride-Along Program, I agree to be bound by all orders, rules, and regulations of the Fresno Fire Department, and to promptly obey all instruction of any Fire Department officer to whom I am assigned. I hereby release the City of Fresno, its officers, agents, and employees from any and all liabilities arising out of my participation in the Ride-Along Program. I have read and understand the contents of this document and sign the same of my own free will. I declare under penalty of perjury that the foregoing is true and correct. Executed this ______ day of _________________________, in Fresno, California. _____________________________________ (Signature of Applicant/Declarant) Section 106.140 Page 3 of 4 FRESNO FIRE DEPARTMENT RIDE-ALONG PARTICIPANT APPLICATION Name CA Driver’s License No. Address Age Date of Birth Cell Phone # Work # Do you have a criminal record? Yes No If yes, please explain: If you have a criminal record, this may be cause for your ride-along application to be denied. Health Information (List any known health problems.) In Case of Emergency notify: Name Relationship Address Cell Phone # Work # Are you related to a member of the Fresno Fire Department? Yes No If yes, employee name Relationship Are you a member of another public safety agency? Yes No If yes, organization name Job Title Name of Supervisor Phone # Yes to either of these questions may bypass the need for a background investigation for approval. Signature of Applicant TO BE COMPLETED BY AUTHORIZING OFFICER Investigator’s Initials Approved Denied BC Name: Station Assigned Date Assigned Time Assigned Reason for Denial By: FD-78 Section 106.140 Page 4 of 4