Mauldin Police Youth Academy Enrollment Application

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1 Mauldin Police Youth Academy Enrollment Application Date: Current Age: Photo of Cadet Applicant s Name: School: Rising Grade: Date of Birth: Home Address: City: State: Zip Code: Name of Parent/Guardian Applicant lives with: (Please attach a photo of the Cadet or if you are filling out this form electronically, please drag and drop a JPEG image into this box) Home Phone: Cell Phone: ***Parent/Guardian Address: Applicant s Uniform Size- (Adult Sizes Only) Shirt: S M L XL XXL Shorts: S M L XL XXL Academy Dates: Boy s Academy - June 6-24 Girl s Academy - July *** You must provide a working address for the application to be accepted. will be the primary means of communication we will use, in reference to your cadet s application

2 Academy & Application Information This application must be filled out in its entirety, or your child will not be considered for the program. ALL CADETS WILL PARTICIPATE IN PHYSICAL TRAINING EACH DAY. An officer will contact you if your child is accepted and explain academy dates, times and locations. There is no charge for participation in the academy, however for some events we may ask the cadets to bring a few dollars for movies or special field trips. Lunch will be provided daily, however on field trip days we will ask the cadet to bring their own lunch. Uniforms will be provided to each cadet at no cost. These uniforms must be worn daily and are the property of the Mauldin Police Department. They must be returned if the cadet is dropped from or quits the academy. The Cadet will be able to keep their uniform upon successful completion of the program. Cadets must bring their own water bottle each day. The parent or guardian is responsible for providing transportation to and from the academy each day for their cadet. Cadets are expected to arrive and be picked up on time each day. Times will run from 8:00am 4:30pm. Cadets whose parents or guardians are repeatedly late will be dropped from the program at the officer s discretion. Your signature below indicates your understanding that if an injury and/or emergency should arise with your cadet, academy staff has the right to notify EMS and/or Fire Department First Responders to treat and/or transport your cadet for further treatment. Your signature also allows EMS and/or Fire Department First Responders to release your child if they feel transportation to the hospital is not medically necessary. An electronic form may be found and filled out at The form must be saved to your computer and ed to: or (must include a picture) For paper submissions, applications may be dropped off at the police department communications center or Mauldin High School made to the attention of MHS SRO. Parent/Guardian Signature:

3 ***Completion and submission of this application In no way guarantees acceptance into the Police Youth Academy*** Police Youth Academy Rules of Conduct ALL CADETS WILL PARTICIPATE IN PHYSICAL TRAINING EACH DAY. Cadets will always address instructors as Officer or sir/ma am and others as Mr., Mrs. or Miss. Cadets will always reply (yes/no) sir or ma am. Cadets will not possess weapons of any kind to include pocket knives, guns, razor blades, or anything else that could be used as a weapon. Cadets will not possess electronic devices of any kind to include I-Pods, MP3 players, cell phones, videogames, or anything else that may be disruptive. Cadets may have cell phones for parent contact only but they must be turned off and stored in a bag. Cadets will not fight, argue, or use profanity. Cadets will wear clothing issued by the academy, in a manner directed by the officers. Shirts will be tucked in, shorts worn properly at the waist. Cadets will not wear jewelry, to include necklaces, earrings, bracelets, rings, or watches. Cadets will not eat or chew gum in class, and will only drink water. Cadets will not possess tobacco products, alcohol, drugs, or any illegal substance. Cadets bringing medication must bring medicine in the original prescription bottle with the cadet s name on it and immediately be given to an Academy Instructor. Cadets will not repeat behavior deemed inappropriate by instructors. Cadets will submit to a search of personal effects when called upon by the instructor. Cadets will not violate state or federal laws or any city ordinance. Cadets who break the code of conduct may be disciplined at the officer s discretion, or may be dropped from the youth academy program at any time.

4 Police Youth Academy Cadet Agreement ***To be completed by the Cadet*** I, agree to attend each session of the Police Youth Academy. I will participate in all activities to the best of my ability. I will be respectful to all officers, instructors and my fellow cadets. At all times I will demonstrate the skills and abilities I have learned while attending the Academy. I understand that while wearing the uniform of the Academy, I am at all times representing the Mauldin Police Department and will conduct myself accordingly. Cadet Signature: ***To be completed by the Parent/Guardian*** I,, agree to pledge my support to the instructors of the Police Youth Academy and re-enforce the skills and abilities taught to my child during the summer. I give Mauldin Police Department permission to photograph my son/daughter during the course of the camp. I understand the photos/video/and other like media may be given to the media and used to promote the camp as determined by the department. Parent/Guardian Signature:

5 Information Form and Release of Liability Disclosure The Mauldin Police Youth Academy will involve a variety of activities that often include warm-ups, games, and rigorous physical activities. Participation in these activities and exercises is mandatory, and is supervised by officers at all times. Certain health or medical information must be made known to the instructors conducting the program, so they are prepared to respond appropriately if the need arises. This information will be held in confidence. Applicant Information: Name Do you have any limiting physical disabilities or handicaps? YES NO If yes, please explain: Can your child swim? YES No Medications/Medical Alerts: How to administer medication and when: List ALL allergies, including food allergies and include the symptoms they cause: Release of Liability: I realize that parts of the Mauldin Police Youth Academy program may be physically or emotionally demanding. I affirm that my child s health is good and he/she is not under a physician s care for any undisclosed condition that bears upon his/her ability to participate. I further understand that each participant must assume the risk of physical injury that could result from any of these activities. I release Mauldin Police Department, the City of Mauldin, and its employees from all liability for any injury to my child from participation in the activities. I hereby state I am the legal guardian of said child and that I am authorized to make this decision. Parent/Guardian Signature Date Cadet Signature Date

6 Emergency Contact Information Parent and/or Guardian Information: Father/Guardian s Name: Father/Guardian s Home Phone: Father/Guardian s Cell Phone: Father/Guardian s Work Phone: Mother/Guardian s Name: Mother/Guardian s Home Phone: Mother/Guardian s Cell Phone: Mother/Guardian s Work Phone: Secondary Contact Information: Name: Address: City: State : ZIP: Relationship to Cadet: Phone: Name: Address: City: State: ZIP: Relationship to Cadet: Phone: Name: Address: City: State: ZIP: Relationship to Cadet: Phone: **Parent/Guardian of Cadet MUST be able to be reached by phone at all times**

7 For Cadet Applicant only Please include a few written lines to tell us about yourself and why you would like to be selected as a Mauldin Youth Academy Cadet

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