Hudson Police Department Summer Youth Academy 2017 Application
AT THIS TIME BOTH SESSIONS ARE FULL. YOU ARE WELCOME TO SIGN UP FOR THE WAIT LIST AND WE LET YOU KNOW.
Email address
Hudson Police Youth Academy
Academy session requested
Childs Name, First
Your answer
Childs Name, Last
Your answer
Male/Female
Date of Birth
MM
/
DD
/
YYYY
Current grade as of TODAY.
Current School Attending
Address
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Parent/Guardian Last Name
Your answer
Parent/Guardian First Name
Your answer
Parent Phone Number home
Your answer
Parent Phone Number Cell
Your answer
Parent Email
Your answer
Emergency Contact number other than Parent
Your answer
Emergency Contact Relationship to Child
Your answer
Food Allergies
Your answer
I give permission for my child’s picture to be taken for program scrapbooks/DVD video, local access television,news paper, youtube, etc. (By checking this box you are agreeing to the above terms.)
Required
Shirt Size
TOWN OF HUDSON/POLICE DEPARTMENT PARENTAL CONSENT AND RELEASE FORM
I, the undersigned parent/ guardian of above applicant, a minor; do hereby consent to his/her participation in voluntary Youth Police Academy sponsored by the Town of Hudson Police Department.

I also agree to forever release the Town of Hudson, the Hudson Police Department and all their employees, officers, agents, board members, volunteers and any and all individuals and organizations assisting or participating in the Youth Police Academy of the Town of Hudson Police Department (“the Releases”) from any and all claims, rights of action and causes of action that may have arise in the past, or may arise in the future, directly or indirectly, from personal injuries to my child or property damage resulting from my child’s participation in the Town of Hudson Police Department’s Youth Academy program.

I also promise, to indemnify, defend and hold harmless the Releases against any and all legal claim and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to my child or property damage resulting from my child’s participation in the Town of Hudson Police Department’s Youth Police Academy program.

I further affirm that I have read the Consent and Release Form and that I understand the contents of this Form. I understand that my child’s participation in these programs is voluntary and that my child and I are free to choose not participate in said programs. By signing this Form, I affirm that I have decided to allow my child to participate in the Town of Hudson Police Department’s Youth Police Academy program with full knowledge that the Releases will not be liable to anyone for personal injuries and property damage my child or I may suffer in the voluntary Town of Hudson’s Youth Police Academy programs.

By Typing your name you agree to the above Parental Consent and Release.
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A copy of your responses will be emailed to the address you provided.
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