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Shop with a Cop - Submission Request Form

Shop with a Cop – Child Participation Request Form

This form is used to gather information about children who may be considered for participation in the annual Shop with a Cop program in Carbon County.

The Price City Police Department sponsors this program and secures funds through grants and community donations. These funds are distributed among all participating law enforcement agencies in Carbon County, with each agency responsible for selecting children from their own communities.

Eligibility

·         Children must be under the age of 18.

·         Children must not have previously participated in Shop with a Cop.

·         Selection is made at the discretion of each agency, based on officer requests and available funding—not on a first-come, first-served basis.

How it Works

·         The number of children selected each year depends on the amount of funds raised.

·         Multiple children from the same family may be submitted on a single form—separate submissions are not required.

·         All requests are confidential and will only be shared with the law enforcement agency reviewing the nomination.

Participating Agencies

·         Price City Police Department

·         Carbon County Sheriff’s Office

·         Helper City Police Department

·         Wellington City Police Department

·         East Carbon City Police Department

·         Utah Highway Patrol

·         Adult Probation and Parole

·         USU–Eastern Police Department

⚠️ This form is intended only for children residing in Carbon County. For Shop with a Cop programs outside of Carbon County, please contact your local law enforcement agency.

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Parent/Guardian Name: *
What is the families current address or city of residence (If known)? *
Best Contact Person and Phone Number for the family: *
To your knowledge, have they participated in the Shop with a Cop Program before? *
Is the family involved with any other similar programs?  (Angel Tree, United Way, Sub for Santa, etc..) *
Child's Name and age (if known)
Child's Name and age (if known)
Child's Name and age (if known)
Child's Name and age (if known)
Child's Name and age (if known)
Child's Name and age (if known)
Why do you feel this child/family should be selected to participate in the annual Shop with a Cop program? *
Which participating agency are you submitting this request to? *
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