Police Youth Academy Registration Form

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August 7th, 2023 through August 11th, 2023

Township of Hamilton Police Department
6101 Thirteenth Street
Mays Landing, NJ 08330

Program Coordinator: Ofc. Dennis Bakker
dbakker@hamiltonatlnj.gov

Participant First Name: *

Participant Last Name: *

Participant Date of Birth *

YYYY

Participant Age at Time of the Youth Week *

Please indicate the age the child will be while participating in the Youth Week.

School Name: *

Grade This Coming Fall:

Home Address: Home Number and Street *

ie. 123 Academy Avenue

Home Address: City/Town *

Home Address: Zip Code *

Home Phone Number: *

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