Teen Academy one week program no cost June 22 to June 26, and July 20 to July 24

Size: px
Start display at page:

Download "Teen Academy one week program no cost June 22 to June 26, and July 20 to July 24"

Transcription

1 Teen Academy The Teen Academy is a one week program designed to give the teens of Rowlett a working knowledge of the Rowlett Police Department. There is no cost to anyone who enrolls. The classes will provide an overview of the various areas of law enforcement, including special weapons and tactics (SWAT), crime scene investigation (CSI), patrol, first aid/cpr, defensive tactics, courts, Taser, etc. This is an educational and informative program that allows teens the opportunity to learn about the issues that affect law enforcement efforts in Rowlett, and help gain an understanding of how our criminal justice system works. The course dates for summer 2015 are June 22 to June 26, and July 20 to July 24 to be held at Coyle or Schrade Middle School (we will not know exact location until May). The Teen Academy consists of a series of classes and hands-on activities held Monday thru Friday from 8:00 AM to 3:00 PM. Lunch and water will be provided each day at no cost, with the exception of Friday. Classes are taught by members of the Rowlett Police Department in their various areas of expertise. Physical activities will be conducted on most days from 2:00 to 3:00. Physical fitness activities will be conducted in a gym and consist of a team sport and stretching. There will be a fun day on Friday, which will consist of a free trip to the Wet Zone; students will need money for anything extra they may want (games, food, snack, etc.). The Teen Academy is open to students who are currently enrolled in the 7 th to 11 th grade. Applicants must be currently enrolled in a GISD school or be participating in a home-school program and must be in good conduct standing. First priority will be given to students who reside in Rowlett. After submitting a completed application, students will be informed as to whether they have been accepted or not by May 15, Class space is limited, a completed application does not guarantee enrollment. The mission of the Teen Academy is to create a better understanding and communication between our youth and the Rowlett Police Department, enhance the students knowledge about law enforcement, and provide a positive interaction with police officers while educating our youth. We hope that all graduates of the Teen Academy will get to know more about the men and women who are protecting their community and why they make the decisions they do while performing that duty. The Teen Academy is NOT designed to make participants certified police officers. Please for any questions or information.

2 Teen Academy Application There is no charge for the program. Classes will be held Monday-Friday 8:00am 3:00pm. Please rank your preference of dates: 6/22-6/26 7/20-7/24 Note: Preferences will be taken into consideration but not guaranteed. If your first choice is filled up, we will move you to the other class. Name: Date of Birth: Address: City Home Phone: Student Cell: Parent Cell: School Attending: Current grade level: Parent Address: Has Student participated in a previous camp: Circle: Yes or No Please ensure addresses are legible as this will be that main source of communication. T-shirt size: Circle: Adult or Youth XXL XL L M S Date: (Signature of Applicant) Date: (Signature of Parent/Guardian) Please return to the SRO at your campus (Rowlett schools only), or scan and application to You can also turn in an application to the Rowlett PD Community Services Division in the second floor of the police department. Officer Garcia RHS Officer Mitchell Schrade MS Officer Praslicka Coyle MS Officer Herring Pearson, Liberty Grove, Herfurth, Steadham, and Keeley Elem Officer Bell Back, Dorsey, Rowlett, and Stephens Elem This application must be completed in full. Completed applications are due no later than Friday, May 8, Applications will be processed in the order in which they are received and will be a first come, first serve basis. For questions or concerns please contact Officer Herring at

3 RELEASE OF LIABILITY WAIVER I,, hereby authorize my son/daughter to participate in the Rowlett Police Department s Teen Police Academy. The Camp will take place on (list dates). I,, also give my permission for my son/daughter to be transported to and from scheduled and specified events by the following mode of transportation: 1) Vehicles owned and operated by the City of Rowlett or GISD. I,, fully understand and my son/daughter fully understands that participation and transportation during the Rowlett Police Department s Teen Police Academy could result in bodily injury, serious bodily injury, illness or death. Although I fully appreciate these risks, I desire my child to participate in the Rowlett Police Department s Teen Police Academy without regard of the consequences. I, the undersigned, assume full and complete responsibility for any accident, injury or illness and or activity that may occur to my child as a result of their participation. I agree to and hereby release, hold harmless, and waive all claims that I, or my child may have against the Rowlett Police Department, City of Rowlett, or any of its employees, agents, sponsors, representatives, or volunteers from all legal injury, illness or death and or activities arising from or connected in any manner to my child s participation in the Rowlett Police Department s Teen Police Academy, including but not limited to liability, damages, legal fees and/or costs caused by or related to the negligence or the intentional act of the Rowlett Police Department, City of Rowlett, or anyone of its employees, agents, sponsors, representatives, or volunteers in whole or in part. This release shall be binding on my heirs, legatees, administrates, and assigns. Parent/Guardian DATE Student Signature DATE RULES OF BEHAVIOR 1) Students will be expected to maintain a mature and respectful attitude towards classmates and instructors. 2) Students will adhere to a strict no touch policy, much like those of school rules. 3) Students are expected to keep up with their personal belongings and should limit what they bring to class (notebooks, pens, etc.) 4) Cell phones must be turned off during class instruction. 5) If possible, girls should refrain from bringing purses to class. 6) Students will be expected to participate in all class activities (unless student is unable, instructor should be given notice of student s physical limitations prior to the start of the academy). 7) Students will be dropped off no later than 8:00 A.M. and picked up no later than 3:00 P.M. Violations of the rules of behavior may result in expulsion from the academy. Parent/Guardian Student Signature DATE DATE

4 MEDICAL INFORMATION- Optional *PLEASE PRINT Date: Name of Applicant: Please list any medical condition the applicant has: List all medications taken by the applicant: Is applicant required to take medication between the hours of 8:00am-3:00pm? Yes/No If yes, what is the medication and the dosage? Is applicant able to administer medication? Yes/No If no, explain: NOTE: All medical emergencies will be treated as such and will be attended to by the Rowlett Fire Department as deemed necessary by academy personnel, instructors or coordinators. Physician Dentist Phone Phone Parent Signature: Date:

5 Rowlett Police Department Photo Release Form I, hereby authorize my child, to be photographed during the 2015 Rowlett Police Teen Academy. I will allow my child s photograph or video to be made public on the city s website, or on any of Rowlett Police Department s social medial sites, such as Facebook and Twitter. Signature Movie/Video Permission Slip I, give permission for my child, to watch video clips of real life police situations that could contain mild language and violence. These video clips will be shown for educational purposes so students understand what a job in law enforcement entails. I understand that my child could also watch a movie some time during the 2015 Rowlett Teen Police Academy. The students will not be shown any movie or video clips with a rating over PG-13. Signature

TOWN OF POUGHKEEPSIE POLICE DEPARTMENT

TOWN OF POUGHKEEPSIE POLICE DEPARTMENT TOWN OF POUGHKEEPSIE POLICE DEPARTMENT INFORMATION PACKET OVERVIEW The Town of Poughkeepsie Police Department is seeking to provide an innovative program for youth residing in the Town of Poughkeepsie.

More information

2014 High School Police Academy Application Packet. Session 1: July 7 th 11 th Session 2: August 11 th 15 th

2014 High School Police Academy Application Packet. Session 1: July 7 th 11 th Session 2: August 11 th 15 th 2014 Application Packet Session 1: July 7 th 11 th Session 2: August 11 th 15 th The Charlotte-Mecklenburg Police Department is offering high school students in Mecklenburg County the opportunity to experience

More information

Georgia Tech North Ave. NW Atlanta Ga. 30332

Georgia Tech North Ave. NW Atlanta Ga. 30332 Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways

More information

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661 Thank you for your interest in the Apex Police Department Law Enforcement Explorer Program. Please complete the following steps so we are able to process your application. Fill out the application completely

More information

Lake Burton Day Camp For Boys and Girls Ages 6-9

Lake Burton Day Camp For Boys and Girls Ages 6-9 Lake Burton Day Camp For Boys and Girls Ages 6-9 Dear Day Camp Parent- In this handbook, we want to acquaint you with the procedures and practices of our YMCA summer camp programs. Thank you for enrolling

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds

More information

Cortland Junior Police Academy

Cortland Junior Police Academy The Cortland Police Department and the Cortland Police Benevolent Association Invite you to participate in the Cortland Junior Police Academy July 29th through August 9th At the Wheeler Avenue Armory Monday

More information

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address:

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address: ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP Zion United Methodist Church ~ 1674 Zion Road Troy, VA 22974 (434) 906-5494 ~ ZionUMCAfterschool@gmail.com Registration 2012 Summer (Available 7am

More information

NORTHWEST PARK & NATURE CENTER Junior Counselor Certification Program 2015

NORTHWEST PARK & NATURE CENTER Junior Counselor Certification Program 2015 Junior Counselor Certification Program 2015 The Junior Counselor Certification Program (JCCP) is a pre-counselor training program for youth ages 14-17, which focus upon gaining the skills necessary to

More information

Cassidy s Cause Therapeutic Riding Academy 6075 Clinton Rd Paducah, KY 42001 270-554-4040

Cassidy s Cause Therapeutic Riding Academy 6075 Clinton Rd Paducah, KY 42001 270-554-4040 VOLUNTEER / INTERN APPLICATION 2014 Thank you for your interest in volunteering with Cassidy s Cause! Our volunteers are the backbone of our program and without them our riders could not ride. Please complete

More information

Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program!

Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program! Greetings! Thank you for your interest in the Illinois Association for College Admission Counseling s 2015 CAMP COLLEGE program! These waiver forms must be completed and submitted in order for your application

More information

Community House High School Programs Standing with families since 1969

Community House High School Programs Standing with families since 1969 Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster

More information

K I D S C A M P 2 0 1 4

K I D S C A M P 2 0 1 4 K I D S C A M P 2 0 1 4 June 9-12 8 a.m. 4 p.m. Grades 3-12 Fee: $50 Join us for a fun-filled learning experience! For an application packet Please stop by the Ben Hill-Irwin Campus at 667 Perry House

More information

Youth Camp Civic Center

Youth Camp Civic Center Youth Camp Civic Center Household ID # Please circle the session(s) that your child(ren) will attend Session One June 8- June 12 Session Two June 15 June 19 Session Three June 22 June 26 Session Four June

More information

Bartow County C.E.R.T.

Bartow County C.E.R.T. Dear Applicant, I would like to take this opportunity to thank you for your interest in the Community Emergency Response Team. The CERT Program is presented by the Bartow County Emergency Management Agency

More information

Youth Programs Registration Form Summer of Service (SOS) 2015

Youth Programs Registration Form Summer of Service (SOS) 2015 Youth Programs Registration Form Summer of Service (SOS) 2015 Participant s Information PHONE GENDER: FEMALE OF BIRTH SCHOOL GRADE IN FALL 2015 MALE ETHNIC BACKGROUND AFRICAN ASIAN INDIAN LATINO NATIVE

More information

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program Page 1 of 5 Intake Sheet Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Father/Mother/Guardian:

More information

J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade

J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade Our day camp offers structured activities from 8:00 a.m. to 5:00 p.m., 5 days a week for an eight-week program, all at one low price. Children

More information

Camper Information Form

Camper Information Form Camper Information Form NO CAMP HELD ON JULY 4, 2016 Please Mark Dates Attending: Session 1: June 27 July 8 Session 2: July 11 July 22 Session 3: July 25 August 5 ALL 3 SESSIONS Personal Information Name

More information

Arkansas Teen College

Arkansas Teen College Arkansas Teen College Central Arkansas Premier Summer Enrichment Program June 15-26, 2015 Half Day Sessions 8 a.m. 12 p.m. /1 p.m. 5 p.m. Grades 6 th through 12 th Application Please complete and return

More information

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

More information

SUMMER ZOO CAMP 2016

SUMMER ZOO CAMP 2016 Scholarships are non-transferable INDIVIDUAL ZOO CAMP SCHOLARSHIP SUMMER ZOO CAMP 2016 APPLICATION AND GUIDELINES APPLICATION DEADLINE March 18, 2016 1 2016 SCHOLARSHIP GUIDELINES Thank you for your interest

More information

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program:

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program: Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5 Respite Program: Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth

More information

CAMP MSC SENSATIONAL SUMMER SCIENCE

CAMP MSC SENSATIONAL SUMMER SCIENCE CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day

More information

Palace Youth Theatre Behavioral Guidelines

Palace Youth Theatre Behavioral Guidelines Palace Youth Theatre Behavioral Guidelines Please sign and return the Behavioral Guidelines and Parent Handbook to the Palace Theatre before your first day. We strongly urge you to keep a copy for your

More information

Hope s Youth Ministry High School Retreat

Hope s Youth Ministry High School Retreat Hope s Youth Ministry High School Retreat March 6-8, 2015 Pocono Plateau Cresco, PA Hope s Youth Ministry PO BOX 914, 700 Cooper Rd. Voorhees, NJ 08043 Questions or for further information: dave@meethope.org

More information

First Name Last Name. Street Address. City/State/Zip Code. Home Phone Cell Phone. Date of Birth Social Security # School Name Grade

First Name Last Name. Street Address. City/State/Zip Code. Home Phone Cell Phone. Date of Birth Social Security # School Name Grade Teen Summer Camp Volunteer Program Job Description Teen Summer Camp Volunteer Program Teen Camp Counselor Application Date First Name Last Name Street Address City/State/Zip Code Home Phone Cell Phone

More information

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT This contract is to be signed by both the participant (child) and his or her parent/guardian. This ensures that both the child and the adult understand

More information

PALMETTO Cyber Security Summer Camp 2015

PALMETTO Cyber Security Summer Camp 2015 PALMETTO Cyber Security Summer Camp 2015 Student Registration Form Full Name of Student: Parent/Guardian Name: Parent/Guardian Email: Parent/Guardian Phone Number: County: Tee-Shirt Size: S M L XL XXL

More information

Recreation & Community Services Camp Serendipity Summer Day Camp 2016

Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Camp Phone & Address Performing Arts Center (Youth Center) 800 Hobson Way (805) 385-8168 (Camp Site) (805) 890-6321 (Camp Site Cell)

More information

June 4, 2015. Dear Parents,

June 4, 2015. Dear Parents, June 4, 2015 Dear Parents, We are excited to offer a special opportunity for your students for the 2015-2016 school year from the Vetri Foundation and the Free Library of Philadelphia. The Free Library

More information

This registration form is also accessible online at: https://www.csuohio.edu/business/gyes-2015

This registration form is also accessible online at: https://www.csuohio.edu/business/gyes-2015 STUDENT REGISTRATION FORM Camp Session Dates: June 22, 2015- June 26, 2015 This registration form is also accessible online at: https://www.csuohio.edu/business/gyes-2015 Last Name: First Name: M.I.: Preferred

More information

Mission Statement. Participant Guidelines

Mission Statement. Participant Guidelines Mission Statement The Hoover Boxing Program's mission is to provide Hoover Middle School students a structured and positive environment where kids can remain active and safe during unstructured hours such

More information

City of Holly Springs Citizen s Police Academy

City of Holly Springs Citizen s Police Academy City of Holly Springs Citizen s Police Academy City of Holly Springs Police 3235 Holly Springs Parkway Holly Springs, GA. 30115 Officer Greg Bettis 770.721.7526 dbettis@hollyspringsga.us 1 The Holly Springs

More information

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION In keeping with its commitment to community policing, the Mountlake Terrace Police Department offers qualified persons the opportunity

More information

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male

More information

Race Guide. South Portland. Check-In Party. Be Happy. Be Healthy. Be You. Welcome to The Color Run!

Race Guide. South Portland. Check-In Party. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Be Happy. Be Healthy. Be You. Race Guide South Portland Welcome to The Color Run! Thanks to you and 5,000 of your newest friends for making The Color Run one of America s biggest 5k events! We have made

More information

Citizens Academy Overview

Citizens Academy Overview If you reside, own property, or a own a business in the City of Sarasota, you are invited to apply for the Citizens Academy by downloading an application which is available on the Neighborhood and Development

More information

FRATERNAL ORDER OF ALASKA STATE TROOPERS (F.O.A.S.T.) PRESENTS: 2014 F.O.A.S.T. CSI Forensic Science Camp

FRATERNAL ORDER OF ALASKA STATE TROOPERS (F.O.A.S.T.) PRESENTS: 2014 F.O.A.S.T. CSI Forensic Science Camp How to Register: The complete registration packet must be completed and turned in at time of payment and registration to participate in the F.O.A.S.T. CSI Forensic Science Camp. Please follow registration

More information

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians,

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians, Dear Parents and Guardians, In order to simplify and provide better service to everyone, Rancho Simi Recreation and Park District ( the District ) has implemented the following payment processing procedures

More information

Field Trip, Offsite Tutoring and Transportation Policy

Field Trip, Offsite Tutoring and Transportation Policy Field Trip, Offsite Tutoring and Transportation Policy This policy is intended to protect the safety of School on Wheels, Inc. (SOW) students and volunteers while participating in field trips, offsite

More information

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity:

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity: University of California, Irvine Campus Recreation CLUB SPORTS VOLUNTEER COACH AGREEMENT PLEASE PRINT LEGIBLY Name of Sport Club: Year: Name of Coach: Home Address: Daytime Phone #: Cell Phone #: E-mail

More information

CAMP MSC SENSATIONAL SUMMER SCIENCE

CAMP MSC SENSATIONAL SUMMER SCIENCE CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day

More information

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information

More information

CITIZENS POLICE ACADEMY

CITIZENS POLICE ACADEMY CITIZENS POLICE ACADEMY APPLICATION Welcome to the 2017 Town of Poughkeepsie Citizens Police Academy. The Citizen Police Academy is sponsored by the Town of Poughkeepsie Police Department and is designed

More information

NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973

NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973 MARCH NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973 APPLICATIONS DUE DATE: MAY 1, 2016 The Nathan M. Wolfe Law Enforcement Cadet Academy will be held at the South Carolina Criminal

More information

June 8 - July 24 7:45 a.m. 5:00 p.m. at LHES Grades K-12 Students must be age 5 by June 8, 2015

June 8 - July 24 7:45 a.m. 5:00 p.m. at LHES Grades K-12 Students must be age 5 by June 8, 2015 2015 At Mo olelo O Lāna i, our keiki will learn stories of Lāna i and practice Hawaiian values to improve their skills in: Literature & Creative Writing Math & Science Computers & the Use of Technology

More information

MEMBER INFORMATION Member First Name: Middle: Last: F Date of Birth: / / Child s Student Identification Number:

MEMBER INFORMATION Member First Name: Middle: Last: F Date of Birth: / / Child s Student Identification Number: Office Use: Entry Date: / / Expiration Date: / / Member #: Receipt Number for Membership Payment: Unit Name: (please circle) 01: Pathfinders Children s Center 02: Mary Bremer Patrick Teen Center MEMBER

More information

Annual Field Trip Forms

Annual Field Trip Forms Annual Field Trip Forms Dear Parents: We are excited about the field trips planned for this year. They have a significant role in your child s education. In an effort to provide safe field trips for your

More information

Application for Childcare

Application for Childcare 261 Sky River Parkway Monroe, WA 98272 Tel: (360) 794 4775 DSHS Provider #: 827175 Application for Childcare Child s Name: Grade (current/going into): School: Please indicate which program you will be

More information

Collision Avoidance Training (CAT) Program

Collision Avoidance Training (CAT) Program Collision Avoidance Training (CAT) Program What is CAT For Teens? The Collision Avoidance Training program is an advanced driver training and defensive driver program for licensed teen drivers. The course

More information

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program.

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program. VALOR Before/After School Program School Year 2016-2017 Mar Vista Academy Enrollment Form and General Release for the Before/After School Program State and Federal Programs Student First Name Middle Name

More information

Registration Form. Child s Name: Grade: Age:

Registration Form. Child s Name: Grade: Age: Parent s Name: Address: Email Address: Cell Phone: Emergency Contact Name: Registration Form Home Phone: Number: Child s Name: Grade: Age: School Name: Gender: Male: Female: T-Shirt Size: Small: { } Medium:

More information

Personal History Statement Application for Law Enforcement Explorer

Personal History Statement Application for Law Enforcement Explorer Name: Date Applied: Personal History Statement Application for Law Enforcement Explorer The Plano Police Department Explorer Post 911 909 14 th Street Plano, Texas 75086-0358 Instructions Read these instructions

More information

2013 Health Careers Summer Camp Application Checklist

2013 Health Careers Summer Camp Application Checklist 2013 Health Careers Summer Camp Application Checklist Please use this checklist to confirm that all required documents have been obtained and completed before mailing your complete application packet to

More information

INTERNATIONAL LEADERSHIP OF TEXAS

INTERNATIONAL LEADERSHIP OF TEXAS INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS

More information

POLICE ATHLETIC LEAGUE

POLICE ATHLETIC LEAGUE POLICE ATHLETIC LEAGUE The Police Athletic League (P.A.L.) is a recreation-oriented juvenile crime prevention program that relies heavily on athletics and recreational activities to create and cement the

More information

Cyber Defenders Summer Camp Application Form Instructions

Cyber Defenders Summer Camp Application Form Instructions Cyber Defenders Summer Camp Application Form Instructions The Cyber Defenders Summer Camp is put on by the San Antonio College Computer Information Systems Department. It will be an overview of material

More information

Selah Fire Department Yakima County Fire District # 2

Selah Fire Department Yakima County Fire District # 2 Volunteer Application Packet 2014 Web Application 206 West Fremont Avenue - Selah, Washington 98942 Chief Gary Hanna Business Phone (509) 698-7310 Fax (509) 698-7317 Volunteer Firefighter Thank you for

More information

West Virginia University 2015 Forensic Science Summer Camp

West Virginia University 2015 Forensic Science Summer Camp Thank you for registering for the! This packet contains the following forms that must be completed and returned before the student will be allowed to attend camp: Participant Information Form Event Participant

More information

Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805

Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805 Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805 Are you looking for a summer of reading enrichment and fun???? Then look

More information

SUMMER PROGRAM REGISTRATION

SUMMER PROGRAM REGISTRATION Las Cruces Museum System SUMMER PROGRAM REGISTRATION Please complete this form. One form per student please. Please write legibly. Mail or drop off: Las Cruces Museum System, PO BOX 20000, Las Cruces,

More information

LIABILITY RELEASE. Walk on Water Ministries 3330 Perkinson Lane Merritt Island, FL 32953 (321) 412-8057 Praisedancer.bryan426@gmail.

LIABILITY RELEASE. Walk on Water Ministries 3330 Perkinson Lane Merritt Island, FL 32953 (321) 412-8057 Praisedancer.bryan426@gmail. Walk on Water Ministries 3330 Perkinson Lane Merritt Island, FL 32953 (321) 412-8057 Praisedancer.bryan426@gmail.com LIABILITY RELEASE In consideration of being allowed to participate in horseback riding

More information

For high school teens Time to escape and just BE U BE with God BE loved by God BE forgiven by God BE changed Be with Friends (and make new ones)

For high school teens Time to escape and just BE U BE with God BE loved by God BE forgiven by God BE changed Be with Friends (and make new ones) What: For high school teens Time to escape and just BE U BE with God BE loved by God BE forgiven by God BE changed Be with Friends (and make new ones) Where: Cuyahoga Valley Environmental Education Center

More information

First Baptist Church of College Hill

First Baptist Church of College Hill After School Application Applicant Information Please complete for the primary residence for the child. Child s Full Name: DOB: Date (of application): Street Address Apartment# City State ZIP Code Household

More information

Learning 2 Mastery After-School Reading and Math Program Parent Packet

Learning 2 Mastery After-School Reading and Math Program Parent Packet Parent Packet 700 Pelham Road North, Jacksonville AL 36265 Dear Parents! Welcome to a new and exciting time with the Learning 2 Mastery program. The hours of operation during the program are 3:15 p.m.

More information

C.I.L.T. Counselor in Leadership Training. Program

C.I.L.T. Counselor in Leadership Training. Program C.I.L.T. Counselor in Leadership Training Program C.I.L.T. Volunteer Program Commitment Level Options 9 Week Field Trip Camp: o 9 week commitment o Dates: June 6 August 5 o Full Day Shift, 8:00am 4:00pm

More information

Compass Road to College Summer Tour Application

Compass Road to College Summer Tour Application Compass Road to College Summer Tour Application Student Information Name: Email Address: Sex: F M Birth Date: Primary Language Spoken at Home: English Spanish Other: Current School: School You ll be Attending

More information

Santa Monica College Administrative Regulation - Students Activities and Student Conduct

Santa Monica College Administrative Regulation - Students Activities and Student Conduct Santa Monica College Administrative Regulation - Students Activities and Student Conduct (AR5319-091481) Extracurricular Trips Arrangements for trips by clubs and other non-athletic extracurricular activity

More information

Special Spaces Columbus Volunteer Application

Special Spaces Columbus Volunteer Application Special Spaces Columbus Volunteer Application Name: Title: Ms./Mrs./Mr. Miss Address: City/State: Zip: Best Contact Numbers: E-mail: Emergency Contact: Phone: Are you over the age of 18: yes no If no,

More information

Rowan University s Aim High Science and Technology Academy

Rowan University s Aim High Science and Technology Academy s Aim High Science and Technology Academy (residential) Summer Science and Technology Program for Rising Seniors (Current 11th Graders) July 5, 2015 - July 31, 2015 (Sunday-Friday) STUDENT APPLICATION

More information

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM NOTICE: ALL ATHLETES WILL BE REQUIRED TO HAVE A SIGNED CONSENT FORM BEFORE TAKING THE FIELD. Football Camps of America, LLC. Parental Release Physical Form Waiver

More information

Parent(s) and/or legal guardian(s): Contact Phone Number(s):

Parent(s) and/or legal guardian(s): Contact Phone Number(s): The Salvation Army of Fort Wayne, Indiana 2901 N. Clinton St., Fort Wayne, IN 46805 Tel: 260-744-2311 Community Youth Center & Corps Youth Programs 2015-2016 Permission Slip & Participant Record Child

More information

AMPED YOUTH MINISTRY Program Form

AMPED YOUTH MINISTRY Program Form AMPED YOUTH MINISTRY Program Form Youth participant s full name: Date of Birth: Sex: Male Female Address: Home Phone: Cell Phone: Email: School: Grade: May the youth ministry leaders/ volunteers contact

More information

Stone Oak Athletics. We are looking forward to a fun-filled and safe summer with your camper.

Stone Oak Athletics. We are looking forward to a fun-filled and safe summer with your camper. Summer Day Camp 2010 Session # 1 June 7 June 11 Session # 6 July 12 July 16 Session # 2 June 14 June 18 Session # 7 July 19 July 23 Session # 3 June 21 June 25 Session # 8 July 26 July 30 Session # 4 June

More information

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development

More information

Karate Adventure Summer Camp

Karate Adventure Summer Camp Karate Adventure Summer Camp Our Summer Karate Camp is one of the most unique summer camps available to children. It provides an enriching selection of self defense activities as well as many fun summer

More information

1. COMPLETE & SUBMIT YOUR APPLICATION

1. COMPLETE & SUBMIT YOUR APPLICATION Dear Prospective Young At Art Museum Teen Volunteer, YAA Teen Leadership Program Sponsored by American Express Charitable Fund Thank you for your interest in volunteering with Young At Art Museum. The

More information

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, the undersigned, on behalf of my minor child: ( Participant ), hereby acknowledge that Participant has

More information

GATEWAY DISCOVERY CAMP

GATEWAY DISCOVERY CAMP GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.

More information

Building Bridges through Music Participant Registration Form

Building Bridges through Music Participant Registration Form SOCIAL DIVERSITY FOR CHILDREN FOUNDATION EMPOWERING YOUTH TO EMPOWER CHILDREN WITH DISABILITIES Building Bridges through Music Participant Registration Form Administration Use Only Registration #: Date

More information

2016 Bowdoin Summer Art Camp Registration

2016 Bowdoin Summer Art Camp Registration 2016 Bowdoin Summer Art Camp Registration Hours and Location Bowdoin Summer Art Camp will run for four weeks from June 27 th through July 22 th. The times and length of each session vary. Please refer

More information

Race Guide. Orange County. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run!

Race Guide. Orange County. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Be Happy. Be Healthy. Be You. Race Guide Orange County Welcome to The Color Run! Thanks to you and all of your newest friends for making The Color Run one of America s biggest 5k events! We have made this

More information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

Spring Reins of Life Volunteer Application

Spring Reins of Life Volunteer Application Spring Reins of Life Volunteer Application Please Print Name: Last Middle First Address: City: State: Zip: Home Phone: Work Phone: Email Address: SS Number: Employer: Occupation: Person to be notified

More information

North Dakota College Tour

North Dakota College Tour North Dakota College Tour University of North Dakota North Dakota State University Minnesota State University, Moorhead Friday, October 31 - Saturday, November 1, 2014 Open to Sophomores, Juniors, and

More information

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form 2016/17 Registration Form SAD57 Program Information (Non-refundable registration fee of $25 for NEW participants required at time of registration): Before Care Program Sites (Please circle one) Alfred

More information

JUNE 20 24, 2016 VIDEO GAME DEVELOPMENT SUMMER CAMP

JUNE 20 24, 2016 VIDEO GAME DEVELOPMENT SUMMER CAMP Attention upcoming 7 th - 10 th graders: You are invited to join the IT and Web Design faculty at Carteret Community College for an action packed week of Video Game Design, Development, and Play. JUNE

More information

COLLEGE VOLUNTEER APPLICATION

COLLEGE VOLUNTEER APPLICATION COLLEGE VOLUNTEER APPLICATION Volunteer Services Telephone Number (813)615-7286 TODAY S DATE: / / MALE FEMALE NAME: LAST FIRST MIDDLE NICKNAME ADDRESS: STREET City STATE ZIP CODE PERMANENT ADDRESS EMAIL:

More information

7 th Annual CHICAGO JAZZ PHILHARMONIC

7 th Annual CHICAGO JAZZ PHILHARMONIC 7 th Annual CHICAGO JAZZ PHILHARMONIC Dear Students and Parents: Welcome to the 7 th Annual CJP Jazz Academy. We have an exciting jazz program lined up for the 2 weeks you will be part of our family. Chicago

More information

To apply please complete application and return to: Harris Towers Attn: Volunteer Coordinator 233 Peachtree Street; Suite 1700 Atlanta, Georgia 30303

To apply please complete application and return to: Harris Towers Attn: Volunteer Coordinator 233 Peachtree Street; Suite 1700 Atlanta, Georgia 30303 To apply please complete application and return to: Harris Towers Attn: Volunteer Coordinator 233 Peachtree Street; Suite 1700 Atlanta, Georgia 30303 For more information please call 404-546-6788 Front

More information

Charleston Southern University. CSI @ CSU Camp. June 16 th 20 st, 2014 Participant Application

Charleston Southern University. CSI @ CSU Camp. June 16 th 20 st, 2014 Participant Application Charleston Southern University CSI @ CSU Camp June 16 th 20 st, 2014 Participant Application Please complete all the required information (including signatures) and submit your application and a deposit

More information

Race Guide. Seattle. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Seattle Center Pavillion 305 Thomas St Seattle, WA 98109

Race Guide. Seattle. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Seattle Center Pavillion 305 Thomas St Seattle, WA 98109 Be Happy. Be Healthy. Be You. Race Guide Seattle Welcome to The Color Run! Thanks to you and 7,500 of your newest friends for making The Color Run one of America s biggest 5k events! We have made this

More information

Aquaculture and Conservation Biology Summer Camp 2014 Registration Form

Aquaculture and Conservation Biology Summer Camp 2014 Registration Form All forms and payment are due no later than June 1, 2014 Participant s Name (First, Last) Age Grade in Fall 2014 Sex Street Address Apt.# City, State Zip Code Guardian Name Cell Phone Number E-Mail Address

More information

8 th Grade Event Packet Contents

8 th Grade Event Packet Contents 8 th Grade Event Packet Contents 1) Letter Home About Upcoming Events and Donations please read and mark the appropriate box at the bottom of the page 2) Interested in Chaperoning? check the box and include

More information

Thursday, July 9th, 2015 and Friday, July 10th, 2015 from 7:30 AM to 5 PM

Thursday, July 9th, 2015 and Friday, July 10th, 2015 from 7:30 AM to 5 PM Dear Applicant to Nurse Academy and Parent/Guardian, Thank you for your interest in Nurse Academy 2015. Nurse Academy is designed for the student who is interested in exploring the profession of nursing

More information

YALE UNIVERSITY CITIZENS, THINKERS, WRITERS: REFLECTIONS ON CIVIC LIFE APPLICATION FOR SUMMER 2016

YALE UNIVERSITY CITIZENS, THINKERS, WRITERS: REFLECTIONS ON CIVIC LIFE APPLICATION FOR SUMMER 2016 NOTE: This application can also be completed online at http://humanities.yale.edu/apply APPLICANT INFORMATION First Name Last Name M.I. Street Address Apt/Unit # City State ZIP Code Student Cell Phone

More information

Summer Institute 2015 for CCS Students Arts Impact Middle School (Located on Ft. Hayes Campus) 680 Jack Gibbs Boulevard, Columbus, Ohio 43215

Summer Institute 2015 for CCS Students Arts Impact Middle School (Located on Ft. Hayes Campus) 680 Jack Gibbs Boulevard, Columbus, Ohio 43215 Summer Institute 2015 for CCS Students Arts Impact Middle School (Located on Ft. Hayes Campus) 680 Jack Gibbs Boulevard, Columbus, Ohio 43215 Columbus City Schools will offer the Summer Institute to assist

More information

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail.

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail. OUR CAMPS ARE FOR GIRLS AND BOYS (AGES 5 THRU 14) Visit our website at Junior Golf Camp (9:00am 12:30pm) We start camp early (8:45am) on Monday for check-in and orientation. The camp is designed for beginners

More information