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Application Instructions: Please complete the following online registration form. Make sure to provide all requested documents. The Academy is limited to 10 cadets. Open positions will be filled on a first come, first serve basis. ***THIS ACADEMY WILL BE VIRTUAL ONLY DUE TO COVID-19***
If different than Cadet - list above.
Please list an emergency contact (other than a parent) that can be contacted if the parent's are unreachable:
To be filled out by Parent or Guardian about Cadet.
Does your Cadet have allergies to food, medicines, insects, plants, other?
Please select Yes or No:
Prescription or Over-The-Counter. List N/A if none.
List N/A if none.
Please provide the date of the last inoculation or attach the Cadet's shot record.
This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed activities associated with the Woodland Youth Public Safety Academy, except as noted by me in writing. I have received and read the Insurance Waiver- Release of Liability. In the event of illness or accident in the course of such activity, I request that measures be instituted without delay as the judgment of medical personnel dictates.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
In consideration of being allowed to participate in any way in the Woodland Youth Public Safety Academy (YPSA), and/or Woodland Police and Fire Department affiliated/sponsored programs, related events, and activities, I and/or the minor CADET, the undersigned:
I have read the complete waiver and release and I understand that I may have given up substantial rights by signing. I have not changed this orally and I sign this release voluntarily. The information I have given is accurate and complete.
This is to certify that I, as parent/guardian with legal responsibility for this minor Cadet, do consent and agree to his/her release as provided above of the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence.
*NOTE: If 2nd parent signature is not possible, 1st parent/guardian certifies that the 2nd parent/guardian has authorized this Cadet to pursue this activity and the 2nd parent/guardian agrees to all items stipulated above.
The Woodland Youth Public Safety Academy takes many pictures of the Cadets throughout each academy session to illustrate, for you and them, the many activities in which they are engaged. Some photos are used for publication to promote the Woodland Youth Public Safety Academy and/or Woodland Police Department and/or Woodland Fire Department via digital, print and electronic publishing. This includes Facebook, Instagram, Twitter and other social media outlets in which we utilize.
As the guardian of a minor participant of the Woodland Youth Public Safety Academy, you have the option to allow or not allow use of your minor’s photo or likeness for the above uses. This form is valid from today's date until permission is terminated in writing to the YPSA at 1000 Lincoln Ave., Woodland, CA 95695 (ATTN: Trista Kennedy).
By checking yes, I grant The Woodland Youth Public Safety Academy and Police and Fire Departments, along with its Instructors, staff, employees and sponsors the right to photograph my minor dependent and use the photo and or other digital reproductions of them or other reproduction of their physical likeness for publication processes, whether electric, print, digital or electronic publishing via the internet.
This field is not part of the form submission.
* indicates a required field