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.

Procedure for Requesting a Ride Along

For EMS students, fire trainees, or nursing students please go to the Draper City Fire Department website and complete the Ride Along Training Program Application.
For other Ride Alongs, complete the Ride Along Application.
For High School Internships please contact our Executive Assistant Stephanie Kelson at 385-557-2805.
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 Executive Assistant Stephanie Kelson at 385-557-2805.

Application to the Training Program

Application must be filled out prior to participation. NO ONE will be allowed to participate unless all necessary paperwork is completely filled out and signed.

Applicant Information

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?

Time requested:

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.