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Youth Citizen's Police Academy Waiver

  1. I hereby authorize the Youth Citizens Police Academy's instructors to maintain and administer any prescribed medication to my child.

  2. During the YCPA, I hereby give consent or permission to any licensed physician to hospitalize and secure proper treatment for and to my child named above. I understand that if my child has a health history of which the instructors need to be aware, I am under the responsibility to provide it. This form may be photocopied for use during the program.

  3. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  4. Release from Civil Liability

    I hereby waive any and all claims and demands of whatever nature that I have or may hereafter acquire against the City of Fayetteville, its officers, the Youth Citizens Police Academy, its instructors, the Fayetteville School District and its employees, as a result of my permission for my child’s participation in the Youth Citizens Police Academy on the date and time specified: between the hours of 8:30 a.m. and 3:30 p.m. from June 25th - June 29th (Level 1) and June 11th – June 22nd / July 16th – July 27th (Level 2). I further agree that my child will comply with all the rules of the program and any instructions or orders issued by the program coordinators in connection with the program. I understand that parents are required to provide transportation for students daily. Drop off is between 8 a.m. - 8:30 a.m. and pick up is between 3:30 p.m. - 4 p.m. each day. There will not be supervision before or after these times. Other arrangements must be authorized in writing by the parent. I hereby acknowledge that I fully understand the consequences of this waiver and that it is a voluntary and intelligent act on my part and my child.

  5. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. Program Rules

    Each participant must complete an application and submit it along with a signed “Emergency Authorization” and “Release from Civil Liability” form from participant’s parent or guardian. Except for sickness and emergencies, participants should not be absent from any of the training sessions. Absence from more than one complete day will prevent a participant from graduating. Participants are expected to dress in appropriate attire (please see dress guidelines). Participants shall not be armed at any time during the academy. Participants shall act in a respectful and courteous manner to the instructors and each other. Profanity and disrespect toward any class participant will not be tolerated. I certify that I understand the requirements of participating in this program.

  7. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. I hereby authorize my child to attend the YCPA. I understand that although at no time will my child be placed in any situations that create a danger to his/her well-being, he/she will be placed in close proximity with law enforcement equipment, to include canines, police weapons, and vehicles. I further understand that these situations will be closely monitored by police or other trained personnel.

  9. Parent or Guardian Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  10. Physical Fitness Requirements

    Physical activities are a part of the YCPA, including a physical fitness assessment at the beginning and the end of the program. In addition to these assessments, students will be involved in other daily physical activities, including bicycling, team sports, self-defense and paintball. Bicycles will be provided. If an applicant cannot ride a bicycle, instruction will be provided. Students should wear appropriate clothing and footwear. The YCPA dress code is addressed further in the next section.

  11. Student Dress Code

    Please remember that we are trying to foster a mutual atmosphere of respect and learning for the program participants. We do not feel clothing that is extreme, or draws undue attention to you, is appropriate. If there is an article of clothing which you are unsure of and that is not covered here, please feel free to ask one of your program instructors before you wear it. If you decide to wear any clothing that is NOT appropriate, please be aware that you will be asked to leave until you can change clothes. This is an interactive program. If you wear something that will pose a physical or safety hazard to you or hinders you in any way of participating during the exercises or activities we are doing that day, you will be asked to change or you will be asked to call a parent to pick you up. Participation in ALL activities is mandatory. Pants/Shorts: Shorts must be of proper length, hemmed, and at least reach the tips of the student's fingertips when both arms are hanging at their sides. Pants must fit the student and not sag below the student’s hips or be loose enough that they must be held in place with the wearer’s hands. Shoes: Because of the active role students will be asked to take in the academy, please refrain from wearing shoes that are difficult to move in, or will pose a safety hazard or prevent participation in activities (i.e. platform shoes, flip flops, boots). Athletic/running shoes are recommended. T-Shirts: (2) T-Shirts will be provided and worn at all times unless instructed otherwise while attending the YCPA. The provided T-shirt will be their “Uniform”. If other shirts are suggested for various activities we will be doing, please see the following guidelines for what is not acceptable: No violent, obscene themes, or sexually suggestive designs or pictures. No shirts glorifying or promoting drugs, alcohol, or cigarettes. No messages containing profanity or disrespect to any race, culture, country or religion. No see “through” clothing. Clothes must be appropriately sized. (not excessively tight) Exposure of midriffs (front or back) or low cut shirts are prohibited. Thank you for your cooperation. Please understand that all law enforcement personnel have a dress code that they must adhere to for professional and safety reasons. This is not intended to prevent your expression.

  12. Participant Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  13. Parent or Guardian Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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