Forms • Los Gatos • CivicEngage

Walk with a Cop

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The Walk with a Cop program allows for a community member to meet a uniformed officer in their neighborhood, a commercial business area, or at Civic Center and walk for an hour. This program will extend through Fall of 2022. Fillable sign up-up forms for the program can be accessed on the Los Gatos-Monte Sereno Police Department Community Policing website. Interested Los Gatos or Monte Sereno community members can expect to be contacted within two weeks of completing the form. Walk with a Cop is on a first come basis and is dependent on weather and staffing availability. Interested individuals will list on the fillable form the days of the week and timeframe that best suits their availability. Walk with a Cop participants fall under similar requirements as a ride along and are as follows: Participants are limited to one walk every 6 months and must be at least 15 years old. Persons under the age of 18 years old will be required to provide a signed consent and waiver from their parent or legal guardian. All Walk-Along participants must sign a waiver releasing the Town of Los Gatos, the City of Monte Sereno, the Police Department and their agents from any liability during the ride. When your application is received, you will be scheduled to accompany an officer on a future date. The following conditions must be complied with when participating in the Los Gatos-Monte Sereno Police Department’s Walk with a Cop Program. Please read carefully: ? Neat and Clean attire is to be worn (T-Shirts with expletive or inappropriate printing, excessively baggy pants/jeans would not be considered appropriate) ? Maintain reasonable confidentiality any contacts that you witness ? No cameras, video cameras, or sound recorders will be allowed unless previously approved by the Watch Commander ? All Walk with a Cop applications are subject to review and approval of the Los Gatos Monte Sereno Police Department ? The walk is limited to one (1) hour between the hours of 9:00 am and 5:00 pm ? Understand that a Walk with a Cop may be terminated at any time due to failure to comply with one of the above rules, or due to unusual circumstances which may occur during a shift ? Officers are still subject to emergency calls for service and if unexpected calls arise, your walk time may end early based on the needs of the community ? You may not carry ANY firearms or weapons You may fill out the electronic form and it will be routed to the appropriate designee. The Walk with a Cop forms will be processed upon receipt. Walk with a Cop availability is based upon staffing availability of patrol.	I ACKNOWLEDGE THIS INFORMATION
APPLICANT NAME*
PHONE NUMBER*
ADDRESS*
CITY*
DATE OF BIRTH*
AGE*
CA DRIVER LICENSE/ID NUMBER*
EMAIL ADDRESS*
REASON FOR WALK REQUEST*
REQUESTED WALK DATE*
WHICH WOULD YOU PREFER
I agree that I will not take any photographs or create any recordings from any personal recording device such as a Smartphone or digital camera	YES
I agree that I will not post anything regarding my ride-along experience to any social media websites of any kind without prior approval from the officer	YES
You are encouraged to ask questions about police activities, functions, and duties. This program is provided for your benefit and the more interest you show, the more you will gain from the experience. Arrive approximately 15 minutes prior to your scheduled appointment time. If you are unable to keep this appointment, please contact the watch commander or dispatch at 354-8600 as soon as possible. Transportation home after your walk along cannot be furnished. Assumption of Risk: I voluntarily participate in this activity fully aware of the dangers and risks involved and knowing that the Town of Los Gatos does not guarantee the construction, condition, or safety of the facilities or the equipment, nor the supervision of the activity by its officers, employees and agents. I expressly assume the risk of all loss, damage or injury from my participation in or presence at the said activity. Release of Liability: In consideration of my participation in the Walk with a Cop Program, which consists of residents walking with a police officer during normal patrol duties, sponsored by the Town of Los Gatos, the City of Monte Sereno, and the Police Department, I (on behalf of myself, my heirs, assigns and legal representatives) hereby release the Town of Los Gatos, the City of Monte Sereno, and the Police Department, and the officers, employees and agents of the Town and City, from all liability for personal injury to myself and property damage incurred during or arising out of my participation in said program. I expressly absolve the Town of Los Gatos and City of Monte Sereno, its officers, employees and agents of liability for their negligence. Authorization for Criminal History Inquiry: Recognizing the need for the Los Gatos Monte Sereno Police Department to ascertain the suitability of those who apply for the Walk with a Cop Program, I authorize am employee of the police department to make inquiry into Department of Motor Vehicle, State Department of Justice, County of Santa Clara, and the Los Gatos Monte Sereno Police Department criminal history files and driving history records. SIGNATURE (Type full name for signature)*
If participant is a minor: In consideration for the privilege of participation in the Ride Along Program, which consists of private citizens riding in a patrol car with a police officer during normal patrol duties, sponsored by the Town of Los Gatos, the City of Monte Sereno, and the Police Department, I, the undersigned parent or legal guardian hereby release for ourselves and for the Ride Along Participant, the Town of Los Gatos, the City of Monte Sereno, and the Police Department, and the officers, agents, and employees of the Town and City, from all liability for personal injury to myself and property damage incurred during or arising out of my participation in said program. PARENT NAME AND PHONE NUMBER

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