SAN ANGELO POLICE DEPARTMENT
Park University
CRIMINAL JUSTICE STUDIES
Ride-Along/Shadow Program
Authorization to Release Information for Background Check
Last Name:
First Name:
Middle Name:
Street Address:
Place of Birth:
Identification #:
Sex:
City:
County or City:
ID Type:
License
State:
State.
State of Issue:
Race:
Date of Birth:
Zip:
Country:
SSN:
ID
I, do hereby authorize a review of and full disclosure of all criminal and traffic related records
concerning myself, by and to any duly authorized agent of the San Angelo Police Department,
whether the said records are of a public, private or confidential nature.
I understand that any information obtained by this records check which is developed directly or
indirectly, in whole or in part, upon this release authorization will be considered in determining
my suitability in participating in the Park University/San Angelo Police Department ridealong/Shadow program.
I understand and agree that any records including this authorization to release, once submitted
becomes the property of the San Angelo Police Department.
Student Signature:
Date:
Park University C.J. Director/ Signature
Date:
SAN ANGELO POLICE DEPARTMENT RIDER RELEASE FORM
THE STATE OF TEXAS
COUNTY OF TOM GREEN
RELEASE OF ALL CLAIMS
I, _____________________________ (name) of ___________________________________ (street address), State of
___________________, County of ______________________________, in consideration of being permitted to
participate in the Student Enrichment Program sponsored between the San Angelo Police Department and Park University
along with riding in an automobile owned by the City of San Angelo which is assigned to and used by the San Angelo
Police Department, in the course of said Department’s duties, do hereby, in advance and for the duration of the criminal
justice course in which I am currently enrolled, expressly release, waive and forever discharge, THE CITY OF SAN
ANGELO, SAN ANGELO POLICE DEPARTMENT, OFFICER(S) ______________________________ and any other
of its employees and agents, of and from all liability, actions, claims, demands, damages, costs, judgments and executions
either in law or in equity, which I may have or which may subsequently accrue to me, including any personal injuries or
expenses, death, and/or injuries to property, real or personal, caused by, or arising out of, accompanying an on-duty police
officer on his rounds and riding in an on-duty police vehicle, regardless of whether such injuries, death or damage are
caused in whole or in part by the negligence of the persons or entity mentioned above.
This release is intended to discharge in advance the CITY OF SAN ANGELO and THE SAN ANGELO POLICE
DEPARTMENT its agents and employees, from and against any and all liability arising out of, or connected in any way
with, my accompanying said Officer(s) while on duty and/or riding in said automobile, even though that liability may
arise out of negligence or carelessness on the part of the persons or entity mentioned above, and regardless of
whether that negligence is the sole or concurring cause of the injury, death or damage.
I further understand that serious accidents, assaults and injuries may occur during the participation in, or observance of,
police work, and that participants and bystanders may occasionally sustain mortal or serious personal injury and/or
property damage, as a consequence thereof. Knowing the risks associated with accompanying an on duty police officer on
his/her rounds, and riding in an on-duty police vehicle, nevertheless I hereby agree to assume those risks and to release
and to hold harmless all of the persons or entity mentioned above who might otherwise be liable to me (or my heirs or
assigns) for damages, even though such damages may be caused by the negligence of the persons or entity
mentioned above.
This release is given and signed with my express intent of binding not only myself but also my heirs, executors,
administrators, and assigns to said release, waiver, covenant, and discharge.
I agree to accept and to abide by the policies, rules and regulations of the City of San Angelo and the San Angelo Police
Department and I understand that I must obey the directions of the Officer(s) I accompany and other employees of the
City of San Angelo. I specifically agree to remain in the vehicle at all times when the officer is performing his duties.
I HAVE CAREFULLY READ THE FOREGOING RELEASE, UNDERSTAND ITS TERMS, AND EXECUTE IT
VOLUNTARILY, WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.
Dated this the _______ day of _________________________, 20_____.
_______________ ______________
S.S.#
Tel. #
_____________
D.O.B.
____________________________
Releasor (signature)
______________ _______ ____________ _________________ ________________ ______________
D.L.#,
State
Agency
Address
City
State
STUDENT will ride with: _____________________________ (Shift) ______, on (date) _________________.
Approved ( )
Disapproved ( )
Authorized by:________________________________________________
SAN ANGELO POLICE DEPARTMENT
Park University
Ride-Along/Shadow
Application:
Last Name:
First Name:
Street Address:
H- Phone #:
Middle Name:
Sex:
City:
Race:
Date of Birth:
State:
Age:
Zip:
Other:
Place of Birth:
Identification #:
Place of Employment:
County or City:
State.
Country:
Identification Type:
State of Issue:
License
ID
Supervisor Name:
SSN:
Phone:
Please answer all of the following questions:
1. Are you a student of Park University Criminal Justice/law Enforcement studies?
Yes
No
2. I am currently enrolled in _______________________________
3. Are you considering a future career in criminal justice/law enforcement?
4. Have you ever been arrested by any law enforcement agency?
Yes
Yes
No
Not sure!
No
5. Have you ever received a citation for any CRIMINAL act?
Yes
No
6. Have you ever been convicted of a crime other than traffic?
Yes
No
9. If answer is Yes to questions 6 or 7: explain:____________________________________________________
__________________________________________________________________________________________
10. Do you have any friends or relatives that are employed by the San Angelo Police Department?
Yes
No
If yes, List:_______________________________________________________________________________
Emergency Contact Name:
Employment:
Phone:
Phone:
H:
Address:
Other:
Relationship:
ATTACH A PHOTO-COPY OF YOUR DRIVERS LICENSE OR STATE IDENTIFICATION CARD!
I certify that all information given in this application is true, and I understand that any false statement in my application
may cause the rejection of this application for consideration.
Applicant Signature:
Date:
Park University
CRIMINAL JUSTICE STUDIES
Ride-Along/Shadow Program
RULES AND INSTRUCTIONS
The following are the rules and instructions for participation in the San Angelo Police Department, Park University
Criminal Justice Studies Ride-along/shadow program. Please take the time to carefully read these rules and instructions.
A. In order to participate in the student Enrichment ride-along/shadow program, you must be currently enrolled in a
participating criminal justice course at Park University.
B. All ride-along/shadow students must be in good standing with Park University, have a minimum of a 2.0
cumulative GPA [for the semester].
C. A Ride-along/shadow application packet must be completed by the applicant and submitted to the Park University
Criminal Justice Director for approval. If approved, the application packet is forwarded to the San Angelo Police
Department Community Services Division where a background check is completed on the applicant.
D. If the applicant and his/her application packet is approved, then arrangements will be made by the Police
Community Services Supervisor or designee to schedule and notify the Park University C.J. Director.
E. The San Angelo Police Department retains the right to continue or reject any ride-along/shadow applicant and
their packet despite technical compliance or non-compliance with these rules.
F. The applicant will be notified by the Park University C.J. director of their application status and the student’s
subsequent schedule if applicable.
G. If approved for participation in this program, a range of minimum of 9 hours (as a course enrichment program) or
a 144 hours (as an internship program) are allotted for the students use in the ride-along/shadow program.
H. A minimum of 4 hours ride-along time can be scheduled for each ride-along occurrence, and a maximum of 8
hours scheduled in any one day.
I. A ride-along time sheet must be dated and signed by the officer to whom the student is assigned, acknowledging
the number of hours and assignment completed. This time sheet must then be forwarded to the police community
services supervisor for processing.
J. The student is responsible for the proper completion and submission of said time sheets to the community services
supervisor.
K. The physical attire and manner of dress for participating students must be appropriate for a professional law
enforcement setting. The assigned officer or ANY police supervisor may cancel the ride-along/shadow event if in
their opinion the manner of dress/attire of the student is inappropriate.
L. Possession of any weapons or personal safety devices by the student is not allowed during participation in the
ride-along/shadow.
M. During ride-along events, the student must remain in the police vehicle at all times, unless directed otherwise by
the assigned police officer.
N. The student will obey all requests and commands made by the assigned police officer during their assigned ridealong time.
O. The assigned officer, or ANY police supervisor may cancel the ride-along/shadow event if in their opinion the
student has violated any rule, policy, law, or has demonstrated unacceptable conduct, behavior, language, or for
any reasons of personal safety of the student.
P. A violation of any of these rules by the student is grounds for immediate removal of the student from the program.
I have read these rules and instructions and agree to abide/conform for reasons of participation in the ridealong shadow program.
________________________________________________
Student Signature
_______________
Date
SAN ANGELO POLICE DEPARTMENT
Park University
CRIMINAL JUSTICE STUDIES
Ride-Along/Shadow Time Sheet
Copy of the Rider Release form approved by a supervisor must accompany this form
Student Information: (print) (must be filled out by student)
Name: (last, first, mi)
Date of Birth:
Emergency Contact Name:
Phone:
H:
Address:
Other:
Student Signature:
Date:
Officer Information (must be filled out by assigned officer)
Officer Name:
PIN:
Ride-Along Date:
ID # & State:
Assignment:
Start Time:
End Time:
Total Hours:
Copy of completed and signed Rider Release form presented with this form?
Student verified by valid ID.
Student attire, manner of dress are appropriate?
Student behavior and actions appropriate?
Yes
Yes
Yes
Yes
No
No
No
No
Officer Comments:______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Officer Signature & PIN:
Date:
RETURN COMPLETED FORM TO COMMUNITY SERVICES SUPERVISOR
SAN ANGELO POLICE DEPARTMENT
Park University
CRIMINAL JUSTICE STUDIES
Ride-Along/Shadow Time Request
1. A total of 9 - 144 hours are allotted for your use. Please indicate the date and time that you would prefer to participate.
2. A minimum of 4 hours ride-along time can be scheduled for each ride-along occurrence, and a maximum of 8 hours
scheduled in any one day
3. Understand that any requests to participate will have to take place Monday-Friday 8am-4pm.
4. No dates or times can be guaranteed!
5. A NEW RIDER RELEASE FORM MUST ACCOMPANY THIS TIME REQUEST FORM
6. Requests need to be made at least a month in advance of the requested times and dates.
1ST Choice
Day
Date
Time
# hours
2nd Choice
Day
Date
Time
# hours
Date Submitted to CJ Director:
Student Name: (print)
Student Signature:
FOR Park University C.J. DIRECTOR USE ONLY:
Date request received:__________________ Request is;
Approved
Denied
Comments:__________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________
Park University C.J. Director
____________________
Date
FOR SAPD DEPARTMENT USE ONLY:
Date request received:__________________ Request is;
Approved
Denied
Comments:__________________________________________________________________________
___________________________________________________________________________________
Actual date Assigned:
Day
Date
Time
# hours
Section:
Patrol
Assignment made by:_____________________________________
CID
CSI
Date:__________________