Ride-Along Program: Release and Liability Waiver

I am hereby requesting permission to accompany Gig Harbor Fire & Medic One (GHFMO) personnel on fire or emergency calls. In consideration for granting me permission to engage in these activities, I hereby agree to the following:

I hereby release and agree to hold harmless GHFMO, and all its officers, agents or employees, from any and all liability, loss, death, injury or damage sustained by me resulting from, arising out of, or in any way connected with my accompanying GHFMO personnel on fire or emergency calls, during the authorized ride along period.

I further agree that my activities, during the approved ride along period, are at my own risk and I hereby agree to indemnify GHFMO and all of its officers, agent, and employees from any and all liability, loss or damage which results from, arises out of, or is in any way connected with my activities while participating in the ride along.

I understand that during the ride along, I may be exposed to potential communicable diseases, such as Hepatitis B, MMR and Tuberculosis, from patients receiving medical care and treatment by GHFMO personnel. In certain cases, these communicable diseases could cause serious illness and possibly death.

I acknowledge that I will be present when protected health information (PHI) is discussed between GHFMO personnel and patients. I understand the importance of protecting the confidentiality of patient information, in every form and I agree to the following, as a condition of being allowed to participate in a ride along:

• Not use or further disclose PHI except as permitted under this agreement or as required by law.
• Use appropriate safeguards to prevent use or disclosure of PHI, except as permitted by this agreement.
• Mitigate, to the extent practicable, any harmful effect that is known to me of a use or disclosure of PHI by me in violation of this agreement.

Report to GHFMO personnel any use or disclosure of PHI for by this agreement of which I become aware.

I will immediately notify GHFMO personnel in the event I am injured and/or exposed to a hazardous condition.

I consent and authorize GHFMO to use and reproduce videos and photographs taken of me/my minor child during the ride along experience for publicity purposes.

Participation Consent and Waiver

By participating in the Ride-Along Program, I acknowledge that I have received, reviewed, and fully understand the terms and conditions set forth in the Gig Harbor Fire & Medic One Ride-Along Program: Release and Liability Waiver. I hereby consent to participate in the program under these terms, and I agree to abide by the conditions stated. 

Parent Consent for Minors (Under 18)

If the rider is under the age of eighteen (18), parent's consent and signature is required to participate.

By allowing my minor child to participate in the Ride-Along Program, I acknowledge that I have received, reviewed, and fully understand the terms and conditions set forth in the Gig Harbor Fire & Medic One Ride-Along Program: Release and Liability Waiver. I hereby consent to my child’s participation in the program under these terms, and I agree to ensure my child abides by the conditions stated.