Rider/Observer

Ride Along Waiver
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Please fill out the form below if you would like to request a Ride-A-Long. You will be notified if/when your request has been approved.

If your request is approved, please fill out and sign the downloadable Ride Along Waiver and bring it with you on your scheduled Ride Along day.

* Indicates required field

Date *

First Name *

Last Name *

Email *

Phone Number (Where you can most often be reached) *

If under 18 years of age, name of Parent/Guardian (First and Last). *

Parent/Guardian Phone Number *

Parent/Guardian Email *

Organization Representing *

Dates of Desired Shifts *

Reason for Observation *

Desired Shift Hours *

The following are rules and regulations required to ride along with the Heath Fire Department. By checking the boxes below you understand and agree to abide by all HFD rules and regulations. *

Check this box if you agree to follow all HFD rules and regulations.

Riders/Observers should be well groomed. Long hair shall be tied back. Jewelry and makeup shall be kept to a minimum. The Officer on duty may refuse a ride-along to anyone not properly groomed. *

I agree

Dark colored pants with a dark-colored (navy blue preferred) shirt and dark shoes shall be worn. No jeans, tank tops, t-shirts, tennis shoes, sandals, or worn out items shall be permitted. The Officer on duty may refuse a ride-along to anyone not properly dressed. *

I agree

Riders/Observers are required to provide and wear a mask that covers their nose and mouth at all times during the day. When on runs an N95 mask is required. *

I agree

I attest that if I am suffering from poor health, injury, or illness, including cold, flu or respiratory infection, on the day of the ride-along, I will call to cancel and will not participate. I understand that I may be disqualified for poor health or any condition that cannot be reasonably accommodated. *

I agree

I hereby release the City of Heath, Division of Fire/EMS and its agents from any and all responsibility for an accident, illness, injury or death that may occur while participation either directly or indirectly in the rider program. *

I agree

I attest that I am at least 18 years of age (or have parent/guardian permission) and have not been convicted of a felony or crime(s) involving moral turpitude. I understand that I may be disqualified for prior criminal history, pending criminal action, pending lawsuit against the department, or denial by any supervisor. *

I agree

I understand that students enrolled at an affiliated institution requesting ride time shall receive preference. All other ride time requests will be at the sole discretion of the Fire Chief. *

I agree

Lawful orders and directions from the shift officer or any department member must be obeyed completely and without hesitation or discussion. Failure to comply will result in immediate termination of the observation shift. *

I agree

I understand that I am riding strictly as an observer and will not attempt to take part in any unauthorized activities. I will not become involved in any investigation, discussions with victims or handling of any fire equipment. *

I agree

Riders/Observers shall not, in any knowing way, interfere or diminish the department's ability to deliver service. *

I agree

Riders/Observers must refrain from any activity that could reflect negatively on the City of Heath, Division of Fire, The City of Heath, or its employees. *

I agree

The Rider/Observer may share information obtained on calls ONLY for purposes approved by the Fire Chief. Medical information concerning any individual is confidential and shall not be released. *

I agree

Riders/Observers may use kitchens, restrooms, apparatus bays and training facilities of the HFD's fire stations. Other areas are private living areas and are off limits. No one shall be permitted in these areas without the express permission of the senior officer on duty at that station. *

I agree

All forms and waivers must be completed and signed before the shift begins. *

I agree

Submit

Please fill out the form below if you would like to request a Ride-A-Long. You will be notified if/when your request has been approved.If your request is approved, please fill out and sign the downloadable Ride Along Waiver and bring it with you on your scheduled Ride Along day.

Please fill out the form below if you would like to request a Ride-A-Long. You will be notified if/when your request has been approved.

If your request is approved, please fill out and sign the downloadable Ride Along Waiver and bring it with you on your scheduled Ride Along day.