2019 Granville County Sheriff's Office Teen Academy
Application: (To be completed personally by applicant).
Email address *
Name *
Your answer
Date of birth: *
Your answer
Age: *
Your answer
Gender: *
Phone Number: *
Your answer
Current Address: *
Your answer
T-Shirt Size: *
Pant Size: *
Your answer
Waist Size: *
Your answer
Inseam: *
Your answer
Height: *
Your answer
Weight: *
Your answer
Father's Name and Address: *
Your answer
Mother's Name and Address: *
Your answer
School Information
School: *
Your answer
Grade: *
Your answer
School Address: *
Your answer
Extracurricular Activities (sports, clubs, church, civic) *
Your answer
Emergency Contact
Name of a relative not residing with you: *
Your answer
Address: *
Your answer
Relationship: *
Your answer
Important Information
1. Transportation:
Cadets are to provide their own transportation. For those Cadets wishing to drive their vehicles to the Academy, parking space will be available. However, the vehicle must remain parked until checkout time on Friday.
2. Check In:
At Granville Central High School, Stem, NC at 5:00 p.m. on Sunday, June 16, 2019. PIZZA WILL BE SERVED.
3. Graduation:
Family and Friends of the Cadets are invited to attend a short Graduation exercise, which will take place at 1:30p.m. on Friday, June 21, 2019
4. Every applicant must be of good moral character and come well recommended.
5. All applications must be completed NO LATER THAN May 1, 2019.
6. I shall respect and follow all the Granville Sheriff's Office Teen Academy Program's Principles of Law and Order.
7. I acknowledge that I must obtain a physical from my doctor's office in order to be eligible for the Academy. The physical form can picked up from your school's office.
SIGNATURES
I authorize the verification of the information provided on this form.
Signature of the Applicant: *
Your answer
Date:
Your answer
Signature of Guardian: *
Your answer
Date:
Your answer
EMERGENCY CONTACT AND MEDICAL INFORMATION FOR APPLICANT
Parent Guardian's Name: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
Parent or Guardian's Name: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
ALTERNATIVE EMERGENCY CONTACTS
Primary Emergency Contact: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
Address: *
Your answer
Secondary Emergency Contact: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
Address: *
Your answer
MEDICAL INFORMATION
Hospital/Clinic Preference: *
Your answer
Physician's Name *
Your answer
Phone Number: *
Your answer
Insurance Company: *
Your answer
Policy Number:
Your answer
Date of Last Tetanus Shot: *
Your answer
List PRESCRIPTION MEDICATIONS you are currently using: *
Your answer
Height: *
Your answer
Weight: *
Your answer
Please tell the committee why you would be a good candidate for this program in 150 words or less. *
Your answer
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