EMS University

NORCAL Ambulance Ride-Along Participate Agreement, Non-Disclosure and Liability Waiver

I, ___________________________, have made a voluntary request to ride with NORCAL Ambulance (NORCAL) and to accompany the ambulance crew during performance of their duties. In consideration of the NORCAL’s permission for me to ride in a vehicle assigned to the NORCAL, I hereby declare and agree as follows:

I am over the age of eighteen and I am not a team member of NORCAL Ambulance.

I am aware that the work of the NORCAL Ambulance can be high risk and dangerous and that I may be subjected to the risk of personal injury, death, loss or property damage by accompanying the NORCAL Ambulance crew during the performance of their duties.

I freely, voluntarily and with such knowledge assume the risk of personal injury, death, loss or property damage which may arise while accompanying the NORCAL crew during the performance of their duties.

I release, waive and discharge NORCAL Ambulance (“NORCAL”), and its team members/employees or agents, from responsibility or liability for any and all loss, claim or action that may arise due to personal injury, death, loss or property damage, which I have, or which may accrue, and I, my heirs, executors, administrators and assigns agree to defend and indemnify NORCAL ambulance, its team members/ employees, members or agents, and each of them, against any and all manner of actions, suits, debts, claims, demands, or damages or liability or expense, actual or claimed negligent or wrongful act or omission of mine as a result of riding in any NORCAL Ambulance vehicle, posting in any office or station or while accompanying the ambulance crew during the performance of their duties and resulting from any negligent act or omission on the part of any NORCAL team member;

I agree to abide by all rules and regulations of riding in any NORCAL Ambulance vehicle, posting in any office or station or while accompanying the ambulance crew during the performance of their duties; and

I will not be under the influence of any alcohol, or other disabling drug or medication during my ride with NORCAL Ambulance or posting in any office or station or while accompanying the ambulance crew during the performance of their duties

I understand that under certain circumstances and conditions, I may not be guaranteed a return trip back to the originating NORCAL Ambulance office or station.

This Agreement, Waiver and Release (“Agreement”) is intended, to the extent permitted by law, to release and discharge in advance NORCAL ambulance, its team members/ employees, members or agents, from all liability relating to my voluntary ride in any NORCAL Ambulance vehicle, posting in any office or station or while accompanying the ambulance crew during the performance of their duties. This Agreement is signed freely with full knowledge of the risks and dangers incident thereto.