I give authorization to a physician or surgeon licensed under the provisions of the Medical Practice Act to give me my child care andor emergency medical treatment when necessary Participant or Parent Print Name Signature Date COORDINATOR USE ID: 4383 Download Pdf
Karnataka Sir Sub Request to issue Police Verification Clearance Cert ificate for the Purpose of Sl No Name of the Verification Certificate Amount in Rupees Select appropriate Certificate required 1 2 3 4 Police Verification Certificate PVCPCC for
The ride along is an observer only and should not become involved in or interfere with any situation either physically or verbally 2 Ride al ongs should be dressed in either business attire or neat clean casual attire Jeans shorts spandex leggings
KEALOHA CHIEF OF POLICE SUBJECT INSTRUCTIONS FOR ALL PARTICIPANTS The opportunity to observe police patrol activities is offered to young persons aged 12 through 17 and to interested adults In order to safeguard all participants and to minimize the
Anniversary of PA State Police. “Soldiers of the Law” Memorial Motorcycle Ride. Hershey, PA – Limited to first 400 MCs. Included. :. Blue Knight Escorted 85 mile ride with mid-way rest stop. Guided Police Academy Tour - at 9:30am.
Police Department. Shillington Police Department located in the Borough Park Maintenance Building. POLICE DEPARTMENT RESOURCES. 6 . vehicles: . 2000 Ford Crown Victoria . –unmarked. 2004 Ford Crown .
KEALOHA CHIEF OF POLICE SUBJECT INSTRUCTIONS FOR ALL PARTICIPANTS The opportunity to observe police patrol activities is offered to young persons aged 12 through 17 and to interested adults In order to safeguard all participants and to minimize the
PROTECTIVE SERVICES POLICE DEPARTMENT. W. o. rkplace. . V. iolence. . A. w. areness Presentation. PSP. D. . Mission:. Th. e. . Protective. . Service. s. . Police. . D. e. p. artment. ’. s.
You may either mail this form or return it to any police facility You may also commend and employee by writing a letter to the Chief of Police Los Angeles Police Department PO Box 30158 Los Angeles CA 90030 or to the commanding officer of the police
Prepared By The. Governor’s Center for Local Government Services. October 15, 2014. for. Kennett Square Borough. Kennett Township. London Grove Township. New Garden Township. Demographics of the Communities.
SYLA. 29. th. April 2014. Jodie . Blackstock. . Director of Criminal . and EU Justice Policy. “I take it that the decision [to attend an interview] is mine. If the client ends up not being happy, it would be up to the client to contact somebody else”.
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I give authorization to a physician or surgeon licensed under the provisions of the Medical Practice Act to give me my child care andor emergency medical treatment when necessary Participant or Parent Print Name Signature Date COORDINATOR USE
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SAN DIEGO POLICE DEPARTMENT Page 1 of 2 Police Legal (PEF) 6/14 /2010 RIDE ALONG REQUEST FORM Date Received Home Phone Work Phone Name DOB Home Address STREET CITY/STATE ZIP Busin ess Address STREET CITY/STATE ZIP Occupation Driver’s Lic/ID SS# Division Assigned Shift Desir ed First Ride Along : Y / N Reason Request Received by AUTH ORIZATION FOR MEDICAL TREATMENT I understand and agree that the City of San Diego does not , and will not, provide medical coverage for me/my child, and I WILL BE RESPONSIBL E FOR ANY MEDICAL CO STS INCURRED as a result of participation in the activity. I give authorization to a physician or surgeon, licensed under the provisions of the Medical Practice Act, to give me /my child, ________________________________, care and/or emergency medical treatment when necessary. _____ ___________________ _______ _ ________________________ ______ _______ Participant or Parent (Print Name) Signature COORDINATOR USE Routed to _________________________ Date _______________ Watch ___________ Ride Along File Checked: Y / N Age Waiver: Y / N Captain Waiver: Y / N Records Check Results ____________________Warrant Check Results ___________________ SUPERVISOR USE Officer Assigned ____________________ If Ride Along Den ied, Why?____________________ OFFICER USE Officer Assigned __________________ Contact Date __________ Date of Ride Along _______ Obtain ID/Log Info. __________ Complete waiver _______ Advise Communications _______ Advise of Witness Obligation ___________ Advise of Safety Precautions ________ Officer’s Comments Attached: Y / N SAN DIEGO POLICE DEPARTMENT Page 2 of 2 Police Legal (PEF) 6/14 /2010 RIDE - ALONG WAIVER AND RELEASE O F LIABILITY For and in consideration of the permission granted to me, ____________________________________ (or to my child, ____________________________________), by the City of San Diego to accompany officers of the San Diego Police Department while on patrol, on ____________ (date), I agree that: 1. P articipation in the Ride - Along program is voluntary and I /m y child freely cho ose to participate; 2. I acknowledge that participation may include inherently dangerous activities. I understand that police patrol involves, on occasion, extraordinary circumstances which may be hazardous to person or property, and I assu me and acce pt all risks associated with par ticipation, including bodily injury or death, or other loss, including damage to property; 3. Understanding that participation in the activity could involve pote ntial risks of harm, not limited to those specified a bove, I DO RELEASE, HOLD H ARMLESS AND PROMISE NOT TO SUE THE CITY OF SAN DIEGO AND THE SAN DIEGO POLICE DEPARTMENT, ITS OFFICERS, EMPLOY EES, AGENTS, AND VOLUNTEERS, WITH RESPECT TO ANY AND ALL SUCH INJURY OR L OSS, except that injury or loss which results from the sole gross negligence or willful or wanton misconduct of one of those individuals; 4. I FURTHER AGREE TO I NDEMNIFY AND DEFEND THE CITY OF SAN DIEG O AND THE SAN DIEGO POLICE DEPARTMENT , its officers, employ ee s, agents, and volunteers , FROM AND AGAINST ANY AND ALL LIABILITY IN CURRED as a result of or in any manner related to participation in this activity . 5. I understand that while on patrol I/my child may become a material witness to incidents or events which form the basis for a criminal or civil proceeding. In this event, I/my child may be required by subpoena to testify as a witness. I AM AWARE THAT THIS CONTRACT IS LEGALLY BINDING AND THAT I AM RELEASING LEGAL RIGHTS BY SIGNING IT. I acknowledge by my signature that I have read and understand the terms that are set forth in this agreement. I have entered into this agreement freely and without duress. ________________________ ________ ________________________ ______ _______ Participan t or Parent (Print Name) Signature Date
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