Skip to main content

Ride Along Agreement

San Miguel Fire & Rescue Waives of Claims for Damages, Covenant Not to Sue, and Ride Along Confidentiality Agreement

In consideration of the permission granted to me by San Miguel Fire & Rescue, to accompany emergency personnel, including firefighters, paramedics and emergency medical service technicians, while performing their duties in responding to fires, medical or other emergencies. I hereby waive all claims for death or injury to my person and/or for damage or loss to my property which may be caused by any act or omission of the San Miguel Fire District, its officers, agents, managers or employees. I agree to indemnify the District, its officers, agents, managers or employees for all loss, damage or liability, contingent or direct, which they may sustain because of my acts or conduct during this ride along.

I understand that emergency fire and medical response involves on occasion extraordinary circumstances which may be hazardous to my person or property. I acknowledge that the San Miguel Fire District, its officers, agents, managers or employees, have in no way represented to me that the facilities, vehicles or equipment with which I may come in contact are safe for, or designated for, the use to which I may put them.

I assume the risk of all dangerous conditions or occurrences which may be encountered while I am at the scene of any emergency response or while in route to or from such emergency response or at any time during my ride along. I also waive all specific notice of the existence of such conditions or occurrences, or exposures from third party actions including, but not limited to, hazardous materials, exposure to airborne or bloodborne pathogens including AIDS, hepatitis, TB or other contagious or infectious diseases, gunfire, fire, smoke, explosions, and/or traffic collisions, which can expose me to personal injury or death.

I hereby covenant not to file a claim against or sue the San Miguel Fire District, its officers, agents, managers, employees or insurance carriers, if any, for any claims arising out of any act or omission occurring during my ride along. I understand that while on the ride along, I may become a material or percipient witness to incidents or events which form the basis for a criminal or civil proceeding. In this event, I may be required by subpoena to testify as a witness at my own cost.

Knowing and understanding this, I still wish to participate in the ride along and voluntarily assume all such risks as may occur while I am participating. I agree to follow all precautionary measures and instructions given by any employee of the above agencies. I have also been informed of, and understand, the San Miguel Fire District policies and procedures concerning the privacy of individually identifiable protected health information (PHI), as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

I hereby agree that I will not, at any time, during or after my ride along, disclose PHI acquired during my ride along to any person or entity, internally or externally, except as required or permitted by San Miguel Fire District policies and procedures or as permitted under HIPAA. I understand that this obligation extends to any PHI that I may acquire during my ride along, whether in oral, written or electronic form and regardless of the way I acquire the PHI.

I understand and acknowledge my responsibility to follow San Miguel Fire District policies and procedures concerning HIPAA during and after my ride along. I also understand that unauthorized use or disclosure of PHI will result in the termination of my ride along privilege and that I will be prohibited from riding along in the future for that reason. I also understand that such unauthorized use or disclosure may subject me to civil and criminal penalties under applicable federal and state laws. I further understand that any civil or criminal liability that may arise from my unauthorized use or disclosure of PHI is solely my legal responsibility. I hereby agree to indemnify and hold harmless the San Miguel Fire District, their employees and agents, arising from my unauthorized use or disclosure of PHI, wherever, whenever, or however such use or disclosure may occur. I understand that this obligation will survive the termination of my ride along, regardless of the reason for such termination.

There was a problem saving your submission. Please try again later.
Please wait while your submission is being saved...
Thank you, your submission has been received.