EPD Youth Academy Application

Transcription

1 EPD Youth Academy Application The Enfield Police Academy will be run this year by Officer Becky Leger, the SRO at JFK with assistance from other members of the police department. There will be 2 one-week sessions. Please indicate on the information/ emergency contact form which session you are signing up for. Both sessions will be held at JFK Middle School. DIRECTIONS FOR APPLICATION Completed applications should include the information/emergency contact form, the release/indemnity agreement, photograph permission form, and the applicant essay. Essays must be typed or neatly written. Please answer the following 2 questions: 1.)Why do you want to attend this academy? 2.)Why should we permit you to attend? Return the 4 items listed above to JFK Middle School or the Enfield Police Department in an envelope addressed to Officer Becky Leger. If you have any questions regarding the academy, contact Officer Becky Leger by calling ext or by ing rleger@enfield.org DO NOT CALL JFK MIDDLE SCHOOL FOR INFORMATION IMPORTANT INFO FOR PARENTS AND PARTICIPANTS A T-shirt will be provided for participants on the first day. They can change on arrival, and this must be worn every day. The shirt is theirs to keep. They will need a lunch, water bottle, and must wear athletic type shoes everyday. Participants should arrive by 8:00 AM sharp every day. BEHAVIORAL EXPECTATIONS Although behavioral issues have never been a problem throughout the history of this academy, we still have to emphasize that appropriate conduct is required of every student. Gross misconduct will be grounds for removal from the academy.

2 RELEASE AND INDEMNITY AGREEMENT I, (parent s name) affirm that my son/daughter (child s name) health is good, and that he/she is not under a physician s care for any undisclosed condition that bears upon his/her fitness to participate in the Enfield Police Youth Academy. I recognize the inherent risk of injury or disability in the Enfield Police Youth Academy activities. I, (parent s name) do for my child, release, acquit and discharge the said Town of Enfield, the Enfield Police Department, its staff or any guest from any and all liability, claims, demands, actions and causes of action which I or my representatives, may have by reason of an accident, which might occur while engaged in any activity sponsored by the Enfield Police Department, or it s agency during the August 2016 session of the Enfield Police Youth Academy, and at any location used by the Enfield Police Youth Academy. Should an injury occur, I grant permission for my son/daughter (child s name) to receive necessary emergency treatment by licensed or certified medical personnel at hospital. date / / PARTICIPANT S SIGNATURE date / / PARENT/GUARDIAN S SIGNATURE

3 INFORMATION/ EMERGENCY CONTACT FORM Please check to indicate which session you are applying for. Session #1 (August 8-12) Session #2 (August 15-19) *Please check here if you will be able to attend the other session if your first choice is unavailable Have you attended this program in the past? Student s name: Address: DOB: Home phone: Allergies/Medications (please explain): Mother/guardian name: Address: Home phone: Work: Cell: Best # to call? H W C Father/guardian name: Address: Home phone: Work: Cell: Best # to call? H W C Please list 2 additional emergency contacts: 1.)Name: Phone: Relation: 2.)Name: Phone: Relation:

4 APPLICATION FOR ENFIELD POLICE YOUTH ACADEMY 2016 BOYS AND GIRLS AGES Dates: August 8-12 and Place: JFK MIDDLE SCHOOL Time: 8:00am to 2:00pm

5 PHOTOGRAPH PERMISSION FORM Throughout the history of the Enfield Police Youth Academy, Police Department personnel take photograph of all the activities. Many of the photographs later appear on the Police Department and Town of Enfield website, or the Enfield Press. Prior to any photographs appearing in any of the above, permission must be granted by a parent. Please indicate your wishes below. Child s name I grant permission for my child s photograph to appear in any of the above. I do not grant permission for my child s photograph to appear in any of the above. Parent signature / /

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