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Waiver, Release, and Indemnification Agreement

I hereby request the privilege, for my personal benefit, of accompanying members of the Mulvane Police Department while on general duty, which will include my being in and about city-owned police vehicles and riding in a police vehicle while the same is being used by Mulvane Police Department personnel. 

In consideration of being permitted to ride in police vehicles and otherwise accompany Mulvane Police personnel, I do hereby knowingly waive any and all actions, claims of any nature, which may result from any such activity, and do further release the City of Mulvane, its officers, agents, and employees from any claims, demands, or actions arising there from, and agree to save them harmless there from. It is expressly agreed and understood that I will indemnify the City of Mulvane, its agents, assigns, and subrogees in the event of any loss, damage or claims arising from injuries or damages incurred as a result of the subject nelivity, including injuries or damages sustained as a result of my behavior or actions. This agreement is made in consideration of my being allowed to accompany Mulvane Police personnel in the performance of their duties. I certify that I am over 18 years of age

I agree and premise that for my own safety I will obey all police instructions and directives during my time with Mulvane Police personnel. I agree to ride with and accompany whichever police officers are designated by Mulvane Police supervisory personnel.

Please fill out the application below to request a police ride along.

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ZIP*
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Phone Number*
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Date of requested ride along.*
 
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Please click submit when finished.