Ride Along Form Fort Osage Fire Protection District Ride Along Form Date(Required) MM slash DD slash YYYY Date Requested for Ride Along(Required) MM slash DD slash YYYY Preferred Station(Required)Station 1 - BucknerStation 3 - IndependenceName(Required) First Middile Initial Last Sending Organization (if applicable) Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you over the age of 18?(Required) Yes No Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Enter Email Confirm Email Herein-after referred to as "First Party" and FORT OSAGE FIRE PROTECTION DISTRICT through its Fire Chief, herein-after referred to as "Second Party". WHEREAS, the First Party has illustrated good reasons to ride along on Fire Department equipment and vehicles and the First Party is willing to assume the risk which might be involved in this activity, and WHEREAS, the Fire Department deems the First Party's reasons for requesting such permit to be reasonable and proper. NOW, THEREFORE, in consideration of Second Party's permission for First Party agrees to and does hereby waive, on behalf of himself, his heirs or assigns, any and all claims whatsoever for damages, personal injuries, death or any other loss which First Party may suffer or receive, while in or upon District premises or District owned equipment. First Party further agrees to save and hold harmless Second Party from any and all claims for damages, personal injuries, death or otherwise, arising from, or in the course of, First Party's activity in riding out, including indemnification to Second Party for any investigation or legal expenses incurred as a result of First Party making said use of District premises and equipment. THIS AGREEMENT shall be in force so long as the Party of the First Part shall remain in or upon premises or equipment owned or under control of the Second Party, for the purpose herein-before stated or while using facilities of the Second Party in connection therewith, during the day stated above. IN WITNESS WHEREOF the First Party hereunto set his hand this day and year above.(Required) I agreeSignature(Required) Reset signature Signature locked. Reset to sign again Signature of Legal Guardian if under the age of 18 Reset signature Signature locked. Reset to sign again Name of Legal Guardian (If Applicable) First Middle Initial Last CAPTCHAUntitled
