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Sign Up for a Ride-Along

  1. I am a student enrolled in a college fire science or EMS program.*

  2. Select one:*

  3. Consent for multiple ride-alongs*

  4. Residents are limited to two ride-alongs total unless they are a student in a fire science or EMS program. Ride-alongs are not scheduled on holidays, and requested hours must occur between 7 a.m. and 4 p.m.

  5. Please select dates that are at least two weeks out from today so that we have adequate time to notify and arrange your ride-along with our crews.

  6. In consideration for being permitted to ride in a District apparatus or vehicle and to accompany District personnel on emergency responses or other District matters, I individually and on behalf of my family members, heirs and assigns, hereby release, waive, and discharge the District and its officers, directors, agents, employees, and representatives from any and all liability, causes of action under any theory of law, claims and demands, damages, costs, expenses, and compensation, arising from or relating to any injury or damages to person or property incurred as a result of riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters.

  7. Riding in a District apparatus or vehicle and/or accompanying District personnel during an emergency response or other District matters is inherently dangerous and may result in severe permanent injury or death and can result in exposure to hazardous situations including, but not limited to, forms of physical violence, explosions, hazardous materials exposure, falls, dog bites, motor vehicle accidents, and infectious diseases.

  8. I, individually and on behalf of my family members, heirs or assigns, having read and thoroughly understood the above NOTICE OF INHERENTLY DANGEROUS ACTIVITY, acknowledge that riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters is inherently dangerous, can result in severe permanent injury or death and can cause exposure to hazardous situations including, but not limited to, forms of physical violence, explosions, hazardous materials exposure, falls, dog bites, motor vehicle accidents, and infectious diseases. I hereby knowingly assume any and all risks associated with or arising from riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters. I understand that the District’s insurance does not provide coverage for any aspect of my riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters. I expressly assume all responsibility for securing appropriate insurance coverage.

  9. I understand that while riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters I may receive, come in contact with, observe, hear, or otherwise learn the confidential and protected health information of one or more individuals. I understand that I am prohibited from disclosing an individual’s protected health information which is protected by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Public Law 104-191 and the Privacy Rule promulgated by the U.S. Department of Health and Human Services, 45 C.F.R 160 and 164. I have received a copy of the North Metro Rescue District’s HIPAA Privacy Policy and agree to adhere to the provisions. I understand that if I have any questions I should ask the District personnel I accompany who have received training on the requirements of HIPAA and the Privacy Rule.

  10. In consideration for being permitted to ride in a District apparatus or vehicle and/or accompany District personnel on emergency responses or other District matters, I agree to indemnify, defend, and hold harmless the District and its officers, directors, agents, employees and representatives from and against any loss, liability, damage, claim, cost or expense (including reasonable attorneys’ fees, costs and expenses) of any kind or nature whatsoever resulting from riding in a District apparatus or vehicle and/or accompanying District personnel on emergency responses or other District matters. I agree that the District shall have sole discretion in selecting legal counsel even though I am solely responsible for the payment of the defense costs.

  11. This Release is not intended to, and does not in any manner, limit the privileges and protections afforded the District and its officers, directors, employees, agents, and representatives under the Colorado Governmental Immunity Act, §24-10-101, C.R.S. et seq.

  12. Colorado law governs this Agreement. This Agreement is the entire agreement between the District and I and there are no oral or collateral agreements or understandings. This Agreement may only be amended by a document signed by the District and I. If any provision is held invalid or unenforceable all other provisions shall continue in full force and effect. Waiver of a breach of this Agreement shall not operate or be construed as a waiver of any subsequent breach of this Agreement. This Agreement shall ensure to the benefit of, and be binding upon, the District and me and our legal representatives, successors, and permitted assigns. This Agreement is not intended to, and shall not; confer rights on any person or entity not named as a party to this Agreement. In any dispute arising from or relating to this Agreement, the prevailing party shall be awarded its/his/her reasonable attorneys’ fees, costs and expenses, including any attorneys’ fees, costs, and expenses incurred in collecting upon any judgment, order, or award. This Agreement may be executed in several counterparts and by facsimile, each of which shall be deemed an original and all of which shall constitute one and the same instrument.

  13. Appropriate and professional attire must be worn. Acceptable attire is navy, black or khaki pants, navy or black polo shirt, and black or brown shoes or work boots with rubber soles. Participants should bring a solid color jacket depending on weather conditions. All clothing must be clean and in good condition. The company officer may cancel permission based on the appearance, attitude, or conduct of the guest rider.

  14. In order for us to complete your request for a ride-along, please upload a photo of your valid driver's license.

  15. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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