Ride Along Request
I understand that I must complete this application truthfully to the best of my knowledge. I acknowledge that failure to provide truthful and complete answers may be grounds to deny my participation in this program. I also grant consent for the Travis County Sheriff’s Office to complete a background and warrant check prior to being approved to participate in this program.
Name
*
First Name
Last Name
Address
*
Street Address
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth
*
Sex (As it appears on your Driver's License or ID)
*
Male
Female
Ethnicity
*
Form of Identification
*
Driver's License
State Issued Identification Card Number
Number
*
Number
*
State ID Issued
*
Medical Information
Do you have a medical condition/concern pertinent to this activity that you would like to disclose? * Optional
Yes
No
If yes, please briefly describe your condition.
*
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Requested Ride Information
Preferred Ride Along Date
*
-
Month
-
Day
Year
Date
Preferred Ride Along Time
*
Hour Minutes
AM
PM
AM/PM Option
Preferred Ride Along Location
*
East Travis County
West Travis County
Preferred Ride Along Deputy's Name
Travis County Sheriff's Office | Waiver of Liability
You must provide your signature below as well as scroll and read the entire Waiver of Liability before hitting submit.
Signature of Rider
*
Submit
Should be Empty: