NYPD Application Form 2018 Youth Police Academy

Attention: Parents & Guardians

This form MUST be completed in full and signed in ink below in order for your child to participate. Incomplete applications will not be accepted.

PRINT CLEARLY or TYPE Child’s Last Name (print clearly or type)

Child’s First Name (print clearly or type)

Address (print clearly or type) Apartment Number

City (print clearly or type) Zip Code: N Y

Home Telephone Number: Daytime Emergency Telephone Number - - / - -

Child’s Date of Birth

-

Month Day Year Name of School Child currently attends

Age

Child MUST be 10 years old by the start of the

program.

Female Male

Check One

N Y

ATTENDED PRIOR CITY HOUSING RESIDENT YES NO YES NO

Parent’s e-mail address

Child’s Shirt Size (Check One)

S M L XL 2XL

A Separate Complete Application MUST Be Submitted For Each Child

If more than one of your children is applying to the Academy, please check this box In addition, please write the first and last names of each child you are registering below. Additional Child:________________________________________ Additional Child: ________________________________________

Permission of the Parent or Guardian is Mandatory for Applicants (Please Print) I, _________________________________________________________________ am the Parent/Guardian of:

(Print Child’s Full Name) ______________________________________________________ (hereinafter referred to as the CHILD), I

am over eighteen (18) years of age and reside at (Print Your Address)__________________________________________________.

Parent / Guardian – You MUST Sign Your Name in ink on the Line Below (Application will not be accepted if not accompanied by Parent/Guardian signature)

In consideration of, and for the permission and authority of my CHILD to participate in the Youth Police Academy, which includes classroom instruction, field trips, recreational events, sporting events and physical activities. I hereby release and forever discharge, and shall hold harmless and indemnify the City of New York Police Department, the City of New York and its agents, servants and employees (collectivity hereinafter referred to as the CITY) from all actions, causes of action, suits, debts, sums of money, accounts, damages, judgments, claims and demands whatsoever which I or my CHILD, or our heirs, executors, administrators, successors and assigns may have now or in the future against the CITY arising out of my Child’s participation in the Youth Police Academy including, but not limited to the aforementioned activities and any acts related thereto. This release may not be changed orally.

Please Sign in Ink:

Official Use Only

Please select an Academy Campus closest to your home. Check one box only! The Academy meets Monday through Friday at the following locations:

Bronx Bronx Bronx Manhattan Manhattan Herbert H. Lehman H.S. Roosevelt Campus Samuel Gompers HS P.S. 111 George Washington HS 3000 East Tremont Ave 500 East Fordham Rd 455 Southern Blvd 440 W. 53rd Street 549 Audobon Avenue Bronx, NY 10461 Bronx, NY 10453 Bronx, NY 10455 New York, NY 10019 New York, NY 10040

Brooklyn Brooklyn Brooklyn Brooklyn Tilden H. S. I.S. 14, (Shell Bank) I.S. 218 Boys & Girls HS 5800 Tilden Avenue 2424 Batchelder Street 370 Fountain Avenue 1700 Fulton Street Brooklyn, NY 11203 Brooklyn, NY 11235 Brooklyn, NY 11208 Brooklyn, NY 11213 Queens Queens Queens Queens I.S. 227 I.S. 204 J.H.S. 231 P.S. 197 32-02 Junction Boulevard 36-41 28th Street 145-00 Springfield Boulevard 825 Hicksville Rd Queens, NY 11369 Queens, NY 11106 Queens, NY 11413 Queens, NY 11691

Staten Island Staten Island Staten Island Port Richmond HS I.S. 61 New Dorp H.S. 85 St Josephs Ave 445 Castleton Avenue 465 New Dorp Lane Staten Island, NY 10302 Staten Island, NY 10301 Staten Island, NY 10306

Summer Youth Police Academy 2018 POLICE DEPARTMENT CITY OF NEW YORK

COMMUNITY AFFAIRS BUREAU

The New York City Police Department seeks to provide innovative and effective programs for the City’s young people. The Community Affairs Bureau’s, Youth Police Academy, is such a program. It is designed to establish a positive relationship between the Police Department and the City’s youth.

New York City residents, attending school, between 10 and 16 years old are eligible to attend.

The goals of the academy are:

To enhance responsible citizenship. To provide positive interaction with police officers and to educate young people about the challenges and

responsibility of police work. To encourage young people to take part in other youth programs offered by the Police Department such as: the

Law Enforcement Explorers, Police Cadet Corps and the Police Athletic League.

The 2018 Youth Police Academy is a six (6) week program that will hold sessions five (5) days a week. The Academy will open at 8:30 a.m. (morning), and dismissal will be at 2:00 p.m. (afternoon). Students will attend classroom sessions with lectures, role-plays and demonstrations by police officers in the areas of law, behavioral science, drug prevention, gang resistance, and life skills. Field trips are also part of the curriculum. Transportation to and from the field trips will be provided. Each site is accessible by public transportation. Student should wear comfortable athletic attire and sneakers. A uniform shirt, baseball style cap, carry bag and water bottle will be provided. Lunch will be provided daily.

The Academy will begin on Monday, July 2th and end on Friday, August 10TH, 2018

ENROLLMENT IS FOR A LIMITED TIME ONLY!

To apply for this year’s Youth Police Academy, complete and sign the application and mail it to the address below.

You will be contacted if your child is accepted. Please provide clear and accurate contact information.

Preference will be given to youth applicants who have not previously attended the academy.

Applications are to be submitted by Friday, June 1, 2018.

Mail application to: N.Y.P.D. Youth Strategies Division YPA 2018 25 Elm Place

Brooklyn, NY 11201