Rehoboth Ambulance Committee, Inc
PO Box 156
Rehoboth, MA 02769
Phone: 508-252-2318
Fax: 508-463-0842

Observer Ride Along Application

Thank you for your interest in participating in the Rehoboth Ambulance Committee Observer Ride Along program. To be considered for a ride along, please complete the application below.

Once you submit your application, you will be contacted by a supervisor to schedule the ride along. In order to be conisdered for this program you must possess a CPR card, and submit a copy of it. You must also consent to a CORI check. In addition, you must also download and sign a waiver and HIPPA agreement.

If you prefer to complete a paper application, please download the application through the link below and return it to te Ambulance Committee.

Ride Along Packet

Denotes required field
Please note there are multiple tabs in the application.

  • 1Demographics
  • 2Emergency Contacts
  • 3CPR and Dates
  • 4CORI Release
  • 5Submit Application

At least one emergency contact is required

Emergency Contact 1

Emergency Contact 2

Please have your CPR card with you during your ride along.

Please provide the following additional information to allow us to request your CORI. Providing this information online via this application is optional, and will expedite the scheduling of your interview.
If you choose NOT to provide the information here, you will be required to complete a separate CORI authorization prior to your interview.

Do you wish to provide the necessary CORI information?

By submitting this application, I affirm that all information contained within is true and accurate. I also affirm my understanding of the following:

Ride Along Guidelines

There are inherent risks in participating in a ride-along and all riders are required to fully read, understand, and agree to the instructions and waivers. With the apprpriate safeguards, non-EMS personnel can ride safely and gain a good perspective on EMS operations and the types of services Rehoboth Ambulance provides.

All riders are expected to wear apropriate attire while on a ride-along. This includes dark navy blue or black pants/jeas (no shorts) and black shoes or boots. Dark navy blue t-shirt or sweatshirt is preferred and it must not contain advertising or emblems. A weather appropriate jacket is also advisable

All riders are expected to strictly adhere to the safety and conduct guidelines outlined below.

  • You must follow ALL directions given to you by ambulance personnel
  • At the direction of the crew, you must wear any necessary personal protective equipment
  • You must, at all times, be in the immediate vicinity of the ambulance crew unless directed otherwise. If you need to leave the station, ambulance or crew for any reason, you must notify the ambulance personnel
  • You must wear a seatbelt at all times when riding in a vheicle that is in motion
  • You may NOT assist with patient care
  • You are expected to behave professionally and courteously to patients, bystanders, crew members, and other agencies involved with a call
  • You must immeediately report any injury, illness, or other problem to a crew member

A rider who violates any safety or conduct guideline may have their ride-along terminated

By selecting yes, I have read the above Rehoboth Ambulance ride-along guidelines and I agree to abide by them. I understand that a violation of any of the above policies is grounds for termination of my ride-along. I also consent to the use of my photograph, name, and address by the Rehoboth Ambulance to publicize and make reports about this ride-along program.

Please download the HIPPA Waiver and Waiver of Liability. These forms must be signed and returned prior to beginning your ride along

Ride Along Waivers