Ride-Along Liability Waiver Logo

  • Ride-Along Liability Waiver

  • Purpose: This ride-along is intended to provide an educational experience for those seeking to improve their knowledge and skills in the EMS service. For members of the general public, this program is meant to increase their awareness of the services the University of Arizona Emergency Medical Services provides and how those services are delivered.

    Recommended: The University of Arizona Emergency Medical Services strongly advises participants to have up to date vaccinations including their COVID-19 vaccination. If participants do have their COVID-19 vaccination, please attach proof to this form. If participants do not have their COVID-19 vaccination, they will be required to submit a negative PCR test no earlier than 72 hours before the ride along. UAEMS mask requirements and usage will be based off current CDC, Pima County, and University of Arizona guidance and are subject to change. 

    *The University of Arizona Emergency Medical Service with hereafter be referred to by UAEMS

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  • By signing below the participant agrees to the following:

    Shifts


    Participants are allowed to ride-along with UAEMS during the following shifts: 

    • A Shift: 0700 - 1300
    • B Shift: 1300 - 1900

    I agree to comply fully with any directives, orders, or requests from UAEMS personnel during the Ride-Along Program.

    Participants will be permitted to ride in any department vehicle in our fleet as long as there are enough seat belts and his/her participation does not create a safety concern. A seat belt shall be worn at all times.

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  • By signing below the participant agrees to the following:

    Dress Code and Behaviors
     

    • All participants in the ride-along program shall conduct themselves in a professional manner, since the general public views them as representatives of the Department. Participants must also adhere to the department's grooming and dress standards. Participants must dress in a neat manner and will not be allowed to wear loose clothing and shorts are not allowed. Participants from outside EMS agencies must wear their work uniform/EMT school uniform. If a participant does have an EMT School Uniform, they are allowed to wear their uniform or wear their shirt with jeans and closed toe shoes. If participants do not have access to a work uniform/EMT school uniform, participants may wear scrubs or a navy-blue shirt with jeans and closed toe shoes. NO EXCEPTIONS! Observers will be given an observer vest at the beginning of their ride along. This vest must be worn during all patient interactions.
    • Under no circumstances shall a participant be permitted to take any pictures or video while on a call. Participants are observers only and are not permitted to render medical care. Additionally, members of the general public shall not be placed in a situation where they have access to patient health information.
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  • By signing below the participant agrees to the following:

    HIPAA

    • HIPAA compliance must be followed. All information obtained about patients during the ride along is required to remain extremely confidential. No information may be discussed with any providers who are not on the call or as required by law. Any questions regarding HIPAA during your ride along should be directed to your Shift Supervisor. 
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  • By signing below the participant agrees to the following:

    Risks

    • I acknowledge my understanding that there are many known and unknown dangers and/or risks associated with me riding with an accompanying emergency medical service, including exposure to infectious diseases such as AIDS, Hepatitis, SARS-CoV-2 (COVID- 19), and Tuberculous. I grant a general release for myself, my heirs, executors, administrators, and assigns. I waive, remise and forever discharge and release the University of Arizona and the University of Arizona Emergency Medical Services Department, and any elected or appointed officials, administrators, officers, employees, volunteers, agents, insurers and any other individuals or entities affiliated with such persons and/or entities from any claims, several or otherwise, past, present or future, which can or may ever be asserted as a result of any injuries or damages, physical or mental, sustained by me while I am accompanying any of the persons as mentioned above or entities, whether in or out of a vehicle.
    • I understand that riding along with and observing UAEMS personnel perform their duties comes with many serious health risks, such as, but not limited to exposure to: hazardous materials, infectious diseases, emotionally traumatic situations, fires, explosions and other dangers. I accept and assume these risks.
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  • Final Points

    • I agree to conduct myself in such a way so as not to impede the functions of the crew as they perform routine or emergency duties.
    • I affirm that I am at least eighteen years of age.
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