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Youth Academy

  1. Prescott Valley Police Badge
  2. Prescott Valley Police Department Youth Academy
  3. The academy will run between July 13th-July17th from 08:30AM to 03:00PM daily. 

  4. It is important that Youth Academy participants have not recently engaged or expect to engage in any activity that is criminal, unethical, or improper in nature that might publicly embarrass or cause problems for other Youth Academy participants or the Town of Prescott Valley. 

  5. As a Youth Academy participant you may be observing graphic material and hearing graphic details of police work, therefore, if you are under the age of 18, a parent or guardian's permission is required for you to participate in the academy (please see below of this application). Applications without a parent or guardian signature will not be accepted. 

  6. Last, First, Middle 

  7. Small, Medium, Large, X-Large, XXL

  8. Emergency Contact Information

    Please list the Name, Cell Phone Number, Work Phone Number, Email, and Daytime Address for your guardian. 

  9. Last, First 

  10. Have you ever been arrested and/or convicted of a crime other than a traffic infraction? If YES, please explain below.

  11. Note: A past criminal record alone does not prohibit an individual from participating. 

  12. List the Date(s), Location of Occurrence(s), and what the Crime(s) were. 

  13. Express Waiver, Release of Liability, and Assumption of Risk Agreement

    The participant understands that the Prescott Valley Police Department Youth Academy is a five-day program with classes meeting as described on the attached instructions page. 

    Participant agrees to adhere to the Code of Conduct listed in the application packet. I agree to show courtesy (the showing of politeness in one's attitude and behavior toward others) to the supervising staff and other participants.

    Due to the class size being limited, participant understands the importance of my commitment to attend all of the classes. Furthermore, participant attests that the above information provided by participant is true and accurate to the best of my knowledge and authorize the Prescott Valley Police Department to conduct a criminal history and background check on me prior to the participant's acceptance into the program. 

  14. Last, First 

  15. Last, First

  16. For the Guardian

    I am authorizing my son/daughter to attend the Prescott Valley Police Department Youth Academy. I understand that my son/daughter may see graphic images and hear graphic details related to police work. Furthermore, I consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of my child by the Prescott Valley Police Department. i grant the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. 

    I also herby release the Town of Prescott Valley and it's agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. 

    I recognize and acknowledge that there are certain risks of physical injury to participants, in the above Youth Academy program and i agree to assume the full risk of any such injuries, damage or loss regardless of severity which I or my child/ward may have against The Town of Prescott Valley and its officers, agents, servants and employees as a result of participating in the Youth Academy program. I hereby fully release and discharge the Town of Prescott Valley and its officer, agents, servants, and employees from any and all claims from injuries, damage, or loss which I or my child/ward may have or which I may accrue to me or my child/ward in any of the above program. I further agree to indemnify and hold harmless and defend The Town of Prescott Valley and its officers, agents, servants, and employees from any and all claims resulting for injuries, damages, and losses sustained by me or by my child/ward and arising out of, connected with, or in any way associated with the activities of the Youth Academy Program. 

    I HAVE READ THIS WAIVER RELEASE OF LIABILITY, AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BE SIGNING IT, UNDERSTAINF THAT I AM FREE TO CONSULT LEGAL COUNSEL BEFORE DOING SO, AND FREELY AND VOLUNTARILY SIGN THE SAME WITHOUT INDUCEMENT. 

  17. Last, First

  18. Last, First 

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  20. This field is not part of the form submission.