Loading...

Colbert County Sheriff’s Office

Ride-Along Application 

On behalf of myself, my heirs, executors, administrators, successors, and assigns, as consideration for permission to participate in the Colbert County Sheriff’s Office Ride-Along Program. I hereby agree to forever release and discharge, indemnify, and hold harmless the Colbert County Sheriff’s Office and the county of Colbert, its departments, officers, agents, employees, and all other persons, entities, and political subdivisions, from and against all suits, damages, claims, or other liabilities of whatever kind or nature for personal injuries or death, loss consortium, damage to or loss of property, or any other loss or damage of any kind or nature, known or unknown, foreseen or unforeseen, including attorney’s fees, arising in any way from my participation in the Colbert County Sheriff’s Office Ride-Along Program.

I have carefully read the foregoing General Release and Waiver of Liability and understand the contents thereof, and without duress or undue influence intend to be legally bound by the contents thereof.

Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Participant's Criminal History Consent
Have you ever been convicted of a felony?*
No
Yes
Does the Colbert County Sheriff's Office have your voluntary consent to perform a thorough check of your criminal history for the purpose of verifying your qualifications for registration.*
No
Yes
Have you ever been convicted of domestic violence?*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!