Approval StatusPending Review

PHOTO ID REQUIRED (copy will be retained). APPLICANTS MUST BE AT LEAST 14 YEARS OF AGE

NameKenzie Sharon Rice
Cell Phone5039319213
Home Address4826 Liberty Rd S, apt. 44
Salem, Oregon 97306
Map It
Date of Birth10/09/2002
SSN #542634124
Driver License Number & StateOR
Purpose of Ride

Wanting to ride with my brother, Kobe Everett.

Emergency Contact Information
Emergency Contact NameJaiden Rice
Emergency Contact Phone5035073176
Date You Want to Ride08/21/2026
Time Requested09:30 PM
Patrol observation rides are a maximum of 5-hour duration. You are limited to 1 ride per calendar year. Please schedule as far in advance (7 DAY MINIMUM) as possible. You will be contacted by telephone to confirm whether or not there is a vacancy for the date and time you have selected. IF SELECTED TO RIDE, YOU ARE BEING REQUESTED TO SHOW UP WEARING CLOTHING DEEMED AS BUSINESS CASUAL.
Ride Rules & Acknowledgements
Consent I agree to the privacy policy.
Are you under 18 years of age?No
Applicant SignatureSignature
Date08/06/2026
Parent/Guardian Signature
PD Department Use Only
Records CheckAttach ONLY: Arrest info, Suspect info, Concealed Weapon Permit info, Corrections Client Info
For Officer to Complete