Required fields are marked with asterisks (*)

Draper City Fire Department Ride-Along Application

The Draper City Fire Department (DCFD) Ride-Along program is designed to provide an opportunity for students, members of the medical community, and, on a limited basis, members of the community to observe the dynamic field of firefighting and Emergency Medical Services (EMS). This service is provided as a privilege at the discretion of the Fire Chief or their designee and may be revoked at any time and for any reason. Ride-alongs are only offered between 8:00 AM and Noon, Monday-Friday.

Procedure for Requesting a Ride-Along

Complete the Ride-Along Application.
Rides must be scheduled at least two weeks in advance.

You Must Have:

Application to the Ride-Along Program
Copy or picture of current Driver’s License or picture identification
Signed Acknowledgement of Ride-Along Program guidelines
1. Minors, less than 18 years old, must have a legal guardian sign, agreeing to the guidelines.
Signed Release and Waiver
1. Minors, less than 18 years old, must have a legal guardian sign the release and waiver.
Signed Confidentiality Agreement
1. Minors, less than 18 years old, must have a legal guardian sign the confidentiality agreement
Minor Students affiliated with a school program must have the Affiliated Organization Acknowledgement portion of the Release and Waiver signed.

If you have any questions about the Ride-Along Program or application please contact Draper City Fire Department's Administrative Assistant Annie Albrecht at 385-557-2808.

First Name

Last Name

Date of Birth:

Address

City

Zip Code

Phone Number- Primary

Copy or picture of current Driver’s License or picture identification (max file size 2MB)

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Allowed extensions pdf, jpg, jpeg, png

Place of Employment or School:

Address- Place of Employment or School:

Phone Number- Place of Employment/School

Position/Title -or- Major/Study:

Organization(s) Represented:

What is your interest in participating in this program?

How did you become aware of this program?

Date you are requesting a ride along - option 1

Date you are requesting a ride along - option 2

Station Requested (if any):

Have you ever been arrested?

Yes

Do you have a physical impairment that would limit your activity while participating in the ride-along program?

Yes

Emergency Contact Information:

Name

Relationship:

Phone Number- Primary

Phone Number- Secondary

I have read and understand the procedure for the Ride-Along Program of the Draper City Fire Department. The above information is true and accurate to the best of my knowledge.

Note: By typing in your name, you are signing this agreement electronically. You agree that your electronic signature is the
legal equivalent of your manual signature on this form.