CALIFORNIA STATE UNIVERSITY  POLICE DEPARTMENT 25800 CARLOS BEE BLVD  HAYWARD, CA 94542-3053  PH (510) 885-3791     FX (510)885-3594                upd@.csuhayward.edu                      Ride Along Request Form PLEASE COMPLETE ALL APPLICABLE SECTIONS AND MAIL TO THE ADDRESS ABOVE : I am a: Student Faculty Member Staff Member Visitor I delivered this form In Person Mailed It Faxed It E-Mailed It Last Name: First Name: Street Address: City: Zip: Telephone: Date of Birth: California Drivers License  Number: I hereby release the State of California, the Trustees of the California State University, each and every officer, agent, and employee of California State University, Hayward, from any and all claims and causes of action that I may have in the future, or that any person claiming through me may have or claim to have against any of the above listed institutions or persons, by reason of any accident, illness or injuries, death or other consequences resulting directly from or indirectly from, or in any manner arising out of, or in connection with, my accompanying a Police Department employee in the performance of his/her duties. I certify that I am at least 18 years old, and that I understand I am granted permission to accompany the police officer as an OBSERVER ONLY. I shall not interfere, or in any way hinder the officer in the performance of his/her duties, and I shall obey without hesitation all instructions or directives that the officer may issue to me.     Signature of Requester __________________________________________________ Date Signature of UPD Official  __________________________________________________ Date