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Citrus Heights PAL Application
The annual five dollar registration fee is to be brought or mailed to the Citrus Heights Police Department. Please have your child's name with the fee, and it goes to the PAL Program. If you wish to send by mail, the police department's address is 6315 Fountain Square Drive Citrus Heights, CA 95621, and please have it addressed to the PAL Program.
PAL Logo
Child's First Name *
Your answer
Child's Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Child Phone *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Child's Sex *
School
Your answer
Grade
Your answer
Child Lives With *
Father/Guardian's First Name
Your answer
Father's Last Name
Your answer
Cell Phone
Your answer
E-Mail
Your answer
Mother/Guardian's First Name
Your answer
Mother/Guardian's Last Name
Your answer
Cell Phone
Your answer
E-Mail
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
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