Observer’s Permit & Release From Liability Form

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Observer's Permit & Release from Liability

The Rose Hill Police Department permits observers to ride with officers as an opportunity for citizens to better understand our patrol functions and duties. Citizens aged fourteen (14) or more years of age are welcome to participate in this program. Additionally, any observer under the age of eighteen (18) years of age must have a parent or guardian sign this Release from Liability Form. A background check will be completed prior to approval being granted for the ride-along. A reissuance of this permit may be requested but will be limited per discretion of the Chief of Police or his/her designee. All observers shall wear clean, appropriate clothing and at no time have in possession any type of weapon during the ride-along.

"*" indicates required fields

Observer's Name*

First Last

Date of Birth*

Age*

Phone*

Sex*

DL # / State*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

School (if applicable)*

Date & Time requesting to ride*

Reason for request*

Do you know or are you related to any City of Rose Hill Employee*

If Yes, who?

Comments

This field is for validation purposes and should be left unchanged.