Jacksonville Sheriff's Office

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Teen Police Academy Participant Information
First Name:
Middle Name:
Last Name:
Date of Birth:
Current Age:
Current Grade:
Race:	American Indian/Alaskan Native Asian Black Native Hawaiian/Pacific Islander Unknown White (please check all that apply)
Ethnicity:	Hispanic Origin Not of Hispanic Origin Unknown
Gender:
Home Address:
Address (2nd line):
City:
State:
ZIP Code:
Home Phone Number:
Which class are you interested in?:	Summer 2023
Information about the Parent or Guardian
Parent/Guardian's First Name:
Parent/Guardian's Middle Name:
Parent/Guardian's Last Name:
Relationship:
Email Address:
Parent/Guardian's Phone Number:	Please provide the best number to reach you.
Parent/Guardian's Cell Phone Number:	This may be used to send updates regarding the program.
Emergency Contact Information
Emergency Contact's Full Name:
Emergency Contact's Phone Number:
Additional Information
Do you give permission for the participant to be photographed and participate in social/public media activities?:
Does the participant have any medical conditions and/or allergies that we need to be aware of? :
How Did You Hear About JSO's Teen Police Academy?:

2023 Camp Dates

Registration