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2. *All applicants are subject to a background check*
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Alternate Phone Number
16. Date of Birth*
    Date of Birth
17. Email Address*
19. School*
20. Grade*
22. Have you ever been arrested?*
24. If YES, please explain:
26. Medical Conditions
28. T-Shirt Size (Adult unisex sizes)*
30. Parent/Guardian Name*
32. Parent/Guardian Review and Permission*

    1. YES, I understand and agree
    2. No

    By selecting YES on this form, I grant my child permission to participate in the Essex Police Department Teen Police Academy. I also give permission for members of the Essex Police Department to interview my child with regards to their participation in the Essex Police Department Teen Police Academy. I also give permission to the Essex Police Department to use any photographs generated during the Essex Police Department Teen Police Academy, for the sole purpose of future Essex Police Department Teen Police Academy publications. Individual names of students will NOT be printed.

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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field