1st Annual Bloomfield Junior Police Academy Dear Parent/Guardian: Thank you for your interest in the 1st Annual Bloomfield Junior Police Academy, which will be held at the Bloomfield High School Gymnasium from July, 20 through July 31 st Monday Friday 9:00am 2:00 pm There is No fee to attend the Junior Police Academy, However the Parents or Guardian are required to purchase the Academy Uniform package: T-Shirt, Shorts, Baseball Hat from Atlantic Uniforms, the price will be approx. $47.00 http://njpoliceoutfitters.com/ As part of our application process, we request that you and your child complete this application packet together and return it back to the Bloomfield Police Department for our review. Requirements 1. The child must be a resident of the Township of Bloomfield. 2. The child must currently be enrolled in 6 th 7 th or 8 th Grade. 3. The child must have at least a C grade average in school. A less than C average may not automatically disqualify the child. Exceptions will be made on a case-by-case basis with just cause. Please attach a copy of your child s report card to this application, if available. 4. The child must not have any conduct or disciplinary problems which would preclude him/her from successful participation in the Academy 5. The Child Must have a note from their doctor medically clearing them to participate in all aspects of the Academy. All considerations will be made for any child who may need a modification due to a medical condition with advanced notice. What to Bring in Backpack or Gym bag A Healthy Lunch and Snack ( No Junk Food or Soda) Extra Water, Juice or a Healthy drink Uniform of the day, extra pair of socks and underwear Sun Block Optional Medication if needed If recruit wears glasses have a strap for them
Contact Information Name of Student: Birthdate: School Where Child Attends and Grade: Full Primary Residence: Parent/Guardian Name(s): Phone #: Email: Mother s Name: Address: Home Phone: Cell Phone: E-mail Address: Father s Name: Address: Home Phone: Cell Phone: E-mail Address Emergency Contact Information: Name: Contact Phone # Address: Relationship: Family Physician: Name: Address: Telephone: Date of last visit:
Rules of Conduct There will be No electronic devices permitted in the Academy Cell phones will be allowed but will be turned off and stored during class No jewelry is to be worn except for medical ID jewelry or Religious in nature There will be No profanity used There will be no Fighting tolerated Recruits are required to attend the academy clean every day Recruits are asked to have their hair cut and neat Recruits with long hair will be required to wear a pony tail All Recruits will refer to the Instructors as Sir or Ma am Any infractions of the rules, the Parent or Guardian will have 30 minutes to pick up the child. Sneakers only, No Sandals, Flip Flops or Boots White or Black Socks No colored socks Signature of Recruit: Date: Disclaimer: By signing below, you the guardian, certify that the prospective recruit has consent from any and all legal guardians to attend and fully participate in all aspects of the junior police academy. Signature of Parent/Guardian: Date: ***Mail, Email or Drop off completed applications to the address below*** Attention: Officer Robert Kish Bloomfield Police / Community Policing Division 1 Municipal Plaza, Bloomfield NJ 07003 Office - 973-259-3153 Fax 973-680-4102
The Bloomfield Junior Police Academy will need a parent and/or guardian to permit a background check before each recruit is officially accepted. The refusal to allow for a background check may exclude the recruit from participating in the junior police academy. We require a background check due to the sensitivity and confidentiality of some of the material each recruit will be privileged to. All information obtained will be confidential and available to law enforcement personnel only. Nothing found within the background check will be made public and will be for our in house purposes only. All information received is considered confidential and will not be distributed. By signing below, I represent that I am the primary parent/guardian of and that I give full permission for members of the Township of Bloomfield, and Bloomfield Police Department to run a full background check on my son/daughter. I understand by signing this document I am allowing the aforementioned to check in-house databases, juvenile criminal history databases, any jurisdiction in which my child has resided or has attended school, speak with school officials regarding disciplinary issues, and any other means necessary. I furthermore do not hold the Bloomfield Junior Police Academy or any other member of the aforementioned departments or schools liable for accessing this information. Name of Recruit Printed: Name of Parent/Guardian Printed: Signature of Parent/Guardian: Date of Signature:
FOR OFFICE USE ONLY Date of Background Check: Officer Completing Background Check: Please Circle one: APPROVED or DENIED *** Do Not Attach Any Printouts. All Information Obtained is Confidential***