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Ride-Along Program Request Form

  1. Ride-Along Request Header (1)
  2. Rider's Contact Information
  3. First & Last Needed for Background Check
  4. *Primary Form of Communication
  5. Needed for Background Check
  6. Ride Along Request
    The ride-along program is available on most days of the week, with certain exceptions. Ride-alongs will be from 7:00 am to 10:00 pm. No rider will be permitted to stay overnight at the fire station. We require at least two-weeks notice to ride-out.
  7. *Date requested must be at least two-weeks out*

  8. 7:00 AM Earliest Time Available
  9. 10:00 PM Latest End Time Available
  10. If the first date isn't available
  11. Age Requirement
    I acknowledge that I am at least 18 years old & that a background check will be performed before riding out.
  12. Patient Confidentiality
    Prior to participating in a ride-along, every participant who may come into contact with private health-related information will be required to complete Health Insurance Portability and Accountability Act (HIPAA) training and sign a nondisclosure agreement to keep all confidential information learned during the ride-along confidential.
  13. Good Health Clause
    The participant must be in good health and must not be suffering from any illness or injury, including cold, flu or respiratory infection, on the day of the ride-along.
  14. Waiver or Claims and Release of Liability
    Prior to participating in a ride-along, every person must acknowledge the risks and sign a written waiver of claims and release of liability.
  15. Suitable Attire
    Any person approved to ride-along is required to be suitably dressed in a collared shirt, blouse or jacket, slacks and shoes. Sandals, t-shirts, tank tops, shorts and ripped or torn blue jeans are not permitted. Hats and ball caps will not be worn in the fire apparatus. Jewelry and tattoos should comply with the Personal Appearance Standards Policy. The Operations Assistant Chief or Captain may refuse a ride-along to anyone not properly dressed. Members of the Citizens Fire Academy (CFA) are allowed to wear the approved CFA t-shirt.
  16. SMFD Logo
  17. Leave This Blank:

  18. This field is not part of the form submission.