2. Students may use this online form to register for the Junior Police Academy (JPA) that is sponsored by the Fairfield Police Department. The JPA provides the opportunity to experience the methods and techniques often used in Law Enforcement. The academy will focus on key values of the profession--respect, self-discipline, integrity, equality, education, and physical fitness.  The academy will include daily exercises, scenarios, and training that will help the cadets build an understanding of the profession and its role as public servant and develop and refine critical thinking skills.  The JPA is a week long program for students entering the 7th, 8th or 9th grade at a Fairfield City School or a school located in Fairfield. 

6. Participant First Name *
7. Participant Last Name*
9. Address*
11. City
12. State
13. Zip Code
15. Cell Phone*
16. Date of Birth*
    Date of Birth
17. Shirt Size*
    -- Select One --Youth SmallYouth MediumYouth LargeYouth XLargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult XXLargeAdult XXXLarge
19. Email Address
21. School Information-Please indicate what grade you will be entering and what school you attend.*
23. Please explain why you would like to be selected for the Junior Police Academy.*
27. Consent for Participation*

    1. I consent

    Below are questions for the student's parent or legal guardian to complete.  By filling out this application, you acknowledge that the City of Fairfield, their affiliates, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity. 

    You consent to allow your student to participate in all aspects of the Junior Police Academy. Daily physical fitness will be included and expected unless limitations are expressed in the application. Equipment training including proper use and handling of tasers, pepper ball launchers, and beanbag shotguns, and various other tools and techniques will be taught under supervision of qualified police officers. 

    I hereby consent to all appropriate medical treatment for my student which may be deemed advisable in the event of of injury, accident, and/or illness during any activities. 

    In addition, I understand that while participating in this activity, my student may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the City of Fairfield Police Department.

29. Parent/Guardian's Relationship to Student*
31. Parent/Guardian First Name*
32. Parent/Guardian Last Name*
34. Address (If different than the student's)
36. City
37. State
38. Zip Code
40. Parent/Guardian Cell Number*
41. Alternate Contact Number:
43. Email Address*
47. Additional Authorized Person for Pick-Up
49. First Name
50. Last Name
51. Phone Number
53. Please list any medical concerns that would prohibit your student from participating in physical fitness activities and physical contact during any portion of this Junior Police Academy:

    Please include any medical conditions, medications, or food allergies.

55. Junior Academy Graduation Attendance*

    The end of Junior Police Academy will have a celebratory graduation.  In order to plan for catering, please identify the number of individuals attending including your student.

57. Food Allergies

    Please include any food allergies of those in attendance.

59. Waiver & Release for Participation
    Waiver & Release to Print and Sign

    Must present this waiver on or before the first day of Junior Police Academy in order to participate.

61. For Further Details, Questions or Concerns:

    If you have any questions or concerns, please contact Officer Todd Adamson or Officer Bri Mossman at 513-829-8201. 

Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field