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2. Wichita Falls Police Department Junior Citizen Police Academy Application
4. Which session are you applying for? *
   -- Select One --1 - June2 - July
6. Applicant's First Name*
7. Last Name*
9. Address*
10. Applicant Cell Phone (if applicable)*
12. City*
13. State*
14. Zip*
16. Date of Birth (xx/xx/xxxx)*
17. Current Age*
18. T-Shirt Size*
20. Parent/Guardian*
21. Parent/Guardian Email*
23. Parent/Guardian Home Phone*
24. Parent/Guardian Work Phone*
25. Parent/Guardian Cell Phone*
27. School Attending*
28. Grade Next School Year*
30. Referred by
32. Reasons for wanting to attend the WFPD Junior Police Academy:*
34. What are your expectations of the WFPD Junior Police Academy?*
36. Have you ever been arrested, convicted, or given a ticket?*
    -- Select One --YESNO
37. If yes, please provide details:*
39. List any allergies, including food, medications, or seasonal:*
41. List any physical limitations and/or medical conditions that should be considered while you are engaged in any activities associated with the WFPD Jr. CPA:*
43. Emergency Contact 1 (include full name, address, and phone number)*
45. Emergency Contact 2 (include full name, address, and phone number)*
47. Primary Physician*
48. Physician Phone #*
50. Additional Information*
52. Please review your application carefully and read the statement below before continuing
54. *****Priority will be given to kids who have not yet attended the Junior Police Academy*****
    I/we hereby certify that all the above answers are true and correct to the best of my knowledge and there are no willful misrepresentations or omissions. I/We understand that any falsifications will be grounds for denying participation in or removal from the WFPD JPA. I/We understand that the goal of the WFPD JPA is to educate students only and not to train anyone to be a police officer. I/We understand the importance of attending the full session and abiding by the rules of behavior as outlined in this application. I/We understand that the Wichita Falls Police Deapartment will conduct a limited background check on the applicant. I/We will not hold the City of Wichita Falls, or any person or entity associated with the WFPD JPA liable for any injuries or accidents associated with the WFPD JPA.
56. Parent/Guardian, by checking this box you are agreeing to the above statement of terms and conditions

    1. I Agree
58. Parent/Guardian, enter your full name here to serve as your electronic signature *
59. Date*
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field