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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email Address
14. Phone Number
16. Date of Birth
17. Driver's License Number
19. Waiver and Release

    In consideration of permission granted to me by the Police Department of the City of Marble Falls, to participate in the "Patrol Ride-A-Long" program on the date listed below, I hereby release the City of Marble Falls, its agents, employees, and officers from all claims, demands, actions or damages which I, my heirs, executors, administrators or assigns may have against the City of Marble Falls, and other above described parties for all personal injuries known and unknown, and injuries to property, real estate or personal, caused by, or arising out of the above described activity.  I, the undersigned, have red the RELEASE and understand all of its terms.  I execute it voluntarily and with full knowledge of its significance.  IN WITNESS WHEREOF, I have executed this RELEASE at Marble Falls Texas on the day and year written below.

    PLEASE REMEMBER THAT YOU ARE HERE IN THE CAPACITY OF AN OBSERVER ONLY.  YOU ARE UNDER THE TOTAL AUTHORITY AND RESPONSIBILITY OF THE WATCH COMMANDER/SUPERVISOR/ASSIGNED OFFICER WHILE PARTICIPATING IN THE RIDE-A-LONG PROGRAM.

21. Signature
22. Print Name
24. Parent/Guardian Signature
25. Print Name
27. (For participants under the age of 18, this form must be printed, completed, and signed by a parent or guardian before participation.)
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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