Office of the State Fire Marshal
Ride-Along Request
1. Personal Information
- 1.1 First Name: Madison
1.2 Last Name: Cooper
1.3 Date of Birth: 10/03/1998
1.4 Phone number: 97981018
1.5 Address: Pink Cage Motel Room 5B
1.6 City: Los Santos
1.7 State: San Andreas
- 1.8 Current Occupation: Military Healthcare Provider (U.S. Army Combat Medic Specialist, off-deployment)
1.9 Reason for Ride-Along: I am interested in observing how the department handles emergencies and in broadening my professional development and understanding of their day-to-day activities. Additionally, I am exploring a potential career transition.
1.10 Have you been convicted for a felony or a misdemeanour charge before? Please mark the applicable answer with an X.
[-] Yes [X] No
I, Madison Cooper, agree by signing this document, acknowledge that the opportunity to participate in the San Andreas State Fire Marshals Ride-Along Program is a privilege and that the assigned Deputy Fire Marshal, may discontinue my participation in the Ride-Along Program at any point of time. I agree to allow a background check to be completed by the Office of the State Fire Marshal. I understand that the Ride-Along Program involves riding in an emergency vehicle being operated by a San Andreas State Fire Marshal who is performing both routine and emergency functions involving Firewatch Operations, as well as responses to potential active fire sites. You will be riding in a vehicle that is emergency response capable, and may be on site should a Fire Marshal respond in the capacity of a Law Enforcement Officer enforcing the State Penal Code and/or San Andreas State Fire Code. This may possibly be a risk to myself, which could result in injury, grievous bodily harm or the possibility of death. I agree that the Office of the San Andreas State Fire Marshal will hold no liability for any incident that may occur, at which I may be injured during the duration of the Ride-Along patrol. I have read the regulations of the Ride-Along Program of the San Andreas State Fire Marshals, and the waiver of liability. I understand the contents of the regulations and waiver of liability, and I sign this document freely.
Signature: M.Cooper
Printed Name: Madison Cooper
Date: 30/09/2024