Form Center

Ride-Along Request

2. DUE TO COVID-19, OUR RIDE-ALONG PROGRAM HAS BEEN SUSPENDED UNTIL AT LEAST EARLY 2021. PLEASE VISIT OUR PAGE AGAIN AT THAT TIME.

4. Today's Date*
   Today's Date

5. Information about Durham Fire Department's Ride-Along Program
   Submitting the information requested here indicates your desire to ride along with a Durham Fire Department Emergency Crew. Submission of this form does not imply confirmation or approval of the requested ride-along.

   Submitting the information requested here indicates your desire to ride along with a Durham Fire Department Emergency Crew. Submission of this form does not imply confirmation or approval of the requested ride-along.

7. First & Last Name*

8. Date of Birth*
   Date of Birth

9. Email Address*

11. Current Address - Street, City, State, Zip

13. Primary Phone # (Cell)*

14. Driver's License #*

16. Emergency Contact Name*

17. Emergency Contact's Phone Number*

19. If you are requesting to ride at a specific station or with a specific person, please list that information here.

21. If you have a preference for a ride along date, please list 3 possible dates that you would like to choose for a ride-along. If you are requesting to ride along with a current employee, please check with that person in advance before scheduling a date. List date preferences here.

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field