201 Chief Michael Feeney

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1 2016 Applicants please fill out this application in its entirety and return to the Ridgewood Police Desk at 131 North Maple Avenue before June 1, A fee of $50.00 per applicant will be assessed as tuition for the Academy. Chief Michael Feeney

2 The Village of Ridgewood Police Department s Community Policing Unit will be conducting a JUNIOR POLICE ACADEMY for qualified boys and girls between the ages of ten (10) and fourteen (14). *Note: Nine (9) year olds entering fifth (5 th ) grade will be accepted)* This seven (7) day program will be held at Benjamin Franklin Middle School from Thursday June 23, 2016 through Friday July 1, Upon successful graduation from the JUNIOR POLICE ACADEMY, cadets may be asked to march in the Fourth of July Parade on Monday July 4, There will be a $50.00 tuition for each cadet attending the academy. The tuition shall include two (2) JUNIOR POLICE ACADEMY t-shirts, a water bottle and a ball cap. The daily schedule is from 8:30am until 2:30pm. Cadets are to be dropped off at Benjamin Franklin Middle School. Transportation is the responsibility of the parent or guardian. Please be prompt when dropping off and picking up your children. The Cadet will be required to wear his/her Uniform on each day of the event. (Navy blue pants/shorts are suggested, but are not required) It is required that each Cadet bring his/her own lunch for the first six (6) days. Please clearly label your child s lunch container. Throughout the day there will be several breaks between blocks of instruction, so several snacks/drinks are recommended. Box lunches can be ordered online each day from the Parkwood Deli, at The lunches will be delivered to the Academy. Also, take into account the weather for each day, and try to plan accordingly. An official Graduation Ceremony and Pizza Lunch will be held on Friday July 1, 2016 at 12:00pm. Parents and family are encouraged to attend. Attached, please find the required application forms that must be completed and returned no later than June 1, Space is limited, apply early! Return all forms to the Community Policing Unit of the Ridgewood Police Department, 131 North Maple Avenue (2 nd Floor of Village Hall). See below for contact information if you have any questions/concerns. Lt. Glenn Ender gender@ridgewoodnj.net Ptl. Joseph Youngberg jyoungberg@ridgewoodnj.net (201) (201)

3 VILLAGE OF RIDGEWOOD POLICE DEPARTMENT Chief Michael Feeney Jr. Police Academy Cadet application CADET INFORMATION Last Name First Birthday Age: Street Address Apartment/Unit # City State ZIP School Name and Grade (just completed) Cadet s Gender: M F School Name and Grade (Next Year) T-Shirt Size (CHILDRENS) (Circle One): S M L XL XXL Will you be missing from any day of training? If yes, explain Have you been a cadet in a previous academy? Do you plan to march in the July 4 th Celebration? Will you have to leave early on any day? If yes, explain Parents: Payment is required upon submitting the application. The only form of payment accepted will be a check, made out to the Ridgewood PBA JPA. The cost will be $50.00/cadet. Check # Amount: (One Check per family is acceptable; however, please put the total amount of the check and check number on every application you submit for each sibling) Do you have a sibling also attending the event? If yes, name(s): EMERGENCY CONTACT INFORMATION Please list parent and/or guardian information. Please check one person will be the PRIMARY contact person. Full Name Relationship Primary Contact Address: Cell Phone: Address Full Name Relationship Primary Contact Address: Cell Phone Address Check box, and sign to right, if your child is authorized to be released to walk/ride home after dismissal. Signature: Date: Please list anyone else who IS AUTHORIZED to pick up your child at dismissal (other than person(s) listed above)^: ***Attention Parents/Guardians: If you have more than one child attending this event. Only list the Emergency Contact information (above) on ONE application, write See: Cadet Doe in box #1*** ^ - If you have authorized your child to walk/ride home after dismissal, you can leave this area blank. 2

4 ADDITIONAL INFORMATION Does your child have any medical conditions that may affect him/her while participating in this event? (i.e. Bee Sting, Peanut Allergies, Asthma, Diabetes, etc.) If yes, explain: If yes, above: Does your child require medication for his/her medical condition? Can he/she dispense the medication to him/herself? If yes, explain: Other than medical conditions, does your child have any special needs that the Instructors will need to be aware of? Does your child have a one on one or a class room aid to help facilitate them during school? If yes, will you be providing an aid for your child at the academy? Is there anything else, related to your child behavioral or medical history that you feel would be important for the Instructors to know? Explain: Is there anyone whom is barred (by law) from access to your child? (i.e. restraining orders) Explain: DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. I also understand that any answers that are found to be untrue may disqualify me from the program. Cadet Signature: Parent/Guardian Signature: Date: Date: Please attach, on a separate piece of paper, an essay. The subject of the essay shall be Why I want to be a [insert dream job] when I grow up. This essay should be no less than five hundred words. Parents, you are more then welcome to help your child but we would like for this essay to be in the Cadet s own words. Hand-written or typed is acceptable. THIS AREA INTENTIONALY LEFT BLANK 3

5 In the following pages, please complete and sign all waivers and agreements. Please return them attached to this application, along with assigned essay. 4

6 The undersigned parent/guardian, a resident of the Village of Ridgewood, has requested the opportunity to have their son/daughter participate in the Michael Feeney Junior Police Academy held by the Village of Ridgewood Department of Police. In consideration of granting said request, the undersigned herby, RELEASES and FOREVER DISCHARGES the Village of Ridgewood, the Village of Ridgewood Police Department and the agents or employees thereof, FROM ALL CLAIMS AND CAUSES OF ACTION THAT THE UNDERSIGNED MAY HAVE FOR PERSONAL INJURIES, DAMAGES OR LOSSES OF ANY NATURE WHATSOEVER, which may result or occur at any time the child of the undersigned is in or about a police vehicle and/or participating in functions of the Junior Police Academy. The undersigned further agrees to have their child obey directives of any such Village of Ridgewood Police Officer/Instructor while accompanying said officer, and acknowledges that this privilege of accompanying the Ridgewood Police, and its agents or employees, can be rescinded at any time during the course of the Junior Police Academy, in the sole and absolute discretion of the police officer. The undersigned certifies that their son/daughter is ten (10) to fourteen (14) years of age and has reviewed this application in its entirety. To the best of his/her knowledge, the undersigned certifies that all the information contained therein is accurate. The undersigned has read this document completely, and is signing it at his/her own free will. Applicant/Cadet s Name: Parent/Guardian Name: (Print) Signature Date 5

7 USE OF PHOTOGRAPH PERSONAL RELEASE FORM I,, confirm that I have agreed to be photographed in connection with the 2015 Chief Michael Feeney Junior Police Academy. I hereby grant the Ridgewood Police Department and its successors, assigns and licensees, the following rights worldwide, irrevocable, in perpetuity, in all media now known or hereafter devised: The right to photograph and record me, or my child, in any manner related to the Junior Police Academy. The right to use all images, likeness, photographs and recordings of me, or my child, from this project, including advertising and publicity. Photograph means any photograph or photographic reproduction, still or moving, or any videotape, online, or live television transmission in which the individual is readily identifiable. I expressly release the Ridgewood Police Department from all claims which I may have in connection with the use of my photograph, name, likeness or voice, and I agree to hold the Ridgewood Police Department harmless against any liability, loss or damage (including reasonable attorney s fees) caused by, or arising from, any use of my appearance in the event. By signing below, I acknowledge that I have the capacity to enter into this agreement and that I have read and agree to be bound by its terms. PARENT OR GUARDIAN AUTHORIZATION Print name of participant Signature Date 6

8 RIDGEWOOD POLICE DEPARTMENT MICHAEL FEENEY JUNIOR POLICE ACADEMY RULES and REGULATIONS 1. Raise your hand if you want to speak. 2. Pay attention to the speaker. 3. Do not litter. 4. No foul language will be tolerated. 5. No horse play or fighting allowed. 6. Cadets will treat instructors and fellow recruits with respect. 7. The Junior Police Academy t-shirt and Cap is the Academy Uniform. It shall be worn all day, every day. 8. Cadets will follow the instructions of the Police Officers AT ALL TIMES. 9. Cadets shall tell the truth at all times. Honesty and Integrity are paramount to a successful academy program. 10. The use of electronic devices is limited to taking photographs only. 11. Upon command, cadets will recite (with enthusiasm) the class motto for all to hear. 12. Name tags shall be worn at all times. By signing below, you accept and promise that you will adhere to the above rules and regulations at all times. Failure to do so may result in your dismissal from the Academy. Print name of Cadet Cadet Signature and Date INSTRUCTIONS TO APPLICANT 7

9 Approved applications shall meet the following requirements and assume responsibilities as stated: 1. Cadet MUST be a resident of the Village of Ridgewood. 2. Cadet must be between the ages of ten (10) and fourteen (14) years of age at the start of the event. (Nine (9) year olds will be accepted if he/she is entering fifth (5 th ) grade) 3. The hours of operation for the program will be from 08:30 A.M. to 2:30 P.M.. Roll-Call begins promptly at 08:30A.M., please do not be late. 4. Cadets, upon acceptance to the program, will be advised of the scheduled events planned for the week. The events that are planned are designed to be fun, exciting and educational. Cadets are required to participate in all events, with the exemption of any special needs requirements or restrictions. 5. Participants MUST adhere strictly to Officer/Instructor s instructions and Ridgewood Police Department Junior Police Academy rules and regulations. Failure to follow the instructions of Officer/Instructors, or the rules and regulations will result in the Cadet s removal from the program. All the information contained in this application is correct and truthful, to the best of my knowledge. I have read the above instructions and agree to abide by these regulations. Signature of Applicant (Cadet) Date Official Use Only Date Received: Address Listed: Yes No Time Received: Telephone # Listed for Emerg. Contact: Yes No Tuition Accepted by: Date: Check (#): ( CASH ACCEPTED) Total Amount on Check: (Including Jackal s Game? Yes No ) (If multiple children attending, only one check is required. Indicate the payment amount on only one application) File Created: (Officer, please accept payment and place in envelope on desk. Provide a receipt to payee for monies accepted) Medical Information Forwarded:, to EMS:. Assistant Required: Yes No Special Concerns: Yes No Follow-Up Required: Yes No Follow-Up Conducted By: Date: 8