Ride Along Program

Box 55 Ride Along Waiver

Complete this form before participating in a Box 55 ride along.

Participant information

First name*Last name*Date of birth*You must be 18 years of age or older.Mobile phone*Home phoneStreet address*Street address line 2City*State*ZIP code*

Emergency contact

First name*Last name*Emergency contact phone*

Identity verification

Upload a picture of your state-issued IDOptional · JPEG, PNG, WebP, or PDF · 10 MB maximum.Upload a selfie of yourselfOptional · JPEG, PNG, WebP, or PDF · 10 MB maximum.

Release and acknowledgement

I certify that I am 18 years of age or older. I understand that riding in an emergency vehicle is dangerous and may result in serious injury or death. I agree to hold The Box 55 Association, a 501(c)(3) non-profit organization, harmless for any accident or occurrence that may happen during my ride. I will obey all instructions from Box 55 Association members or related emergency service personnel. I will obey all policies and procedures of the Box 55 Association, The Nashville Fire Department, and any other related emergency services.

I have read and agree to this release and acknowledgement.*

Signed date*

Participant signature*

Protected records

Waiver Records

Waiver records and identity files are available only to administrators.