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SOMERSET COUNTY POLICE ACADEMY
Police Youth Week Registration
402 Roycefield Road
Hillsborough, NJ 08844
908-541-5056
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2019 Police Youth Week
July 15, 2019 to July 19, 2019

Applicant Information: Please populate ALL of the requested information below, then click on Submit at the bottom of the page. An email confirming your acceptance into the class will be forwarded to the email address you provided.

First Name
Last Name
Address
City
Municipality
State
Zip
Residing County
Medical Concerns 
Allergies
Date
Cell Phone
Home Phone
Age
Gender
Height
Weight
Race
E-Mail *For course confirmation.  

Each student will receive two (2) pairs of shirts and shorts. Please indicate the sizes below.
Adult Shirt Size


Adult Short Size
Name of High School Attending

By selecting "Yes," I agree that the student will arrive on time, demonstrate a positive attitude at all times and follow the rules and regulations of the Police Youth Week Program.

Parent/Guardian #1  
First Name
Last Name
Relationship to Student
Work Phone
Cell Phone
Email Address
   
Parent/Guardian #2
First Name
Last Name
Relationship to Student
Work Phone
Cell Phone
Email Address
 
Additional Contact  
First Name
Last Name
Relationship to Student
Work Phone
Cell Phone
Email Address


PRESS/PHOTOGRAPH RELEASE & CONSENT FOR MY CHILD TO PARTICIPATE IN POLICE YOUTH WEEK
By selecting "Yes" below, I state that I am the parent or guardian of the above-mentioned student, a particpant in the Somerset County Police Youth Week Program.

As a condition of attendence:
*  I authorize the Somerset County Police Academy and/or other media sources to photograph and publish pictures of  my child as related to his/her participation in the Police Youth Week Program. Additionally, I authorize the release of my child's name to be reported for publication.
*  I understand that participation in this program includes both classroom exercises and practical physical-based activities.

*  Finally, I will ensure that my attending child is promptly picked up at the scheduled dimissal time/location. Lack of attention to this matter may result in the removal of my child from this program.
* By selecting "Yes," I understand that this is replacing my signature of approval for my child's application and participation.


Cellular phone numbers/e-mail address will be used to make any last minute notifications as may be required
"A Matter of Pride"