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2. DISCLOSURE FOR MINORS
   If you are under the age of 18, DO NOT fill out this online request form. Minors must pick up a ride along request form from the Farmington Police Department (900 Municipal Dr.) and return the completed form with their parent/guardian's signature.
4. Today's Date*
5. Name (First, Middle Initial, Last)*
7. Date of most recent ride-along (if applicable)*
8. Date requested to ride along
9. Shift Requested
11. Officer Requested/Assigned
13. Relationship to officer requested if applicable
15. PARTICIPANT INFORMATION
17. Date of birth*
18. Social Security Number*
19. Driver's License Number & State *
21. Email*
22. Home Phone*
24. Home Address*
    Street, City, State, Zip Code
26. Work Address
    Street, City, State, Zip Code
27. Work Phone
29. Contact with law enforcement*
    Briefly describe any contacts you've had with officers of the department in the last five years. (victim/suspect of crime, traffic ticket, accident, etc.)
31. Reason for ride-along*
    Briefly describe the reason you're requesting to go on a ride-along.
33. Ride-Along Participant Requirements and Rules*

    1. Yes

    1. No

    I have received a copy of the Ride-Along Participant Requirements and Rules (located in PDF form on ride-along web page) and will comply with its contents.
35. Participant Name*
    By providing my electronic signature, I am certifying that the information I provided in this application is accurate.
36. Date*

38. Before participating in any activities with the Farmington Police Department, I acknowledge and affirmatively state that I: 1. Am fully aware that police activities can involve some danger and that I have a responsibility to carefully obey and follow all instructions given me by department employees and to exercise my own considered judgement to protect my safety during these activities. 2. Am in good health and physical condition and that I have fully revealed any health or physical limitations to the department through its employees. 3. I will not participate in any activity until I am sure I understand the instructions and am fully physically and mentally prepared to engage in this activity. 4. RELEASE the City of Farmington and its employees and agents from any liability or claim arising from damage or injury to me or my personal property arising from or occurring during any activities with the Farmington Police Department. 5. Have not participated in a ride along program in the past twelve months, except as provided in Farmington Police Department policy #299-05. 6. I am fully vaccinated against COVID-19 and can provide proof of vaccination if asked to so.

40. Executed on this date*
    Month, day, year
42. Participant Name*
    Electronic Signature
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field