Citizen Police Academy Registration

  • MM slash DD slash YYYY
  • Please provide state where you were born
  • In consideration of the benefits that I will receive from my participation in the New Albany Citizen Police Academy, I do hereby release the City of New Albany, its police officers, public officials, agents, servants, and employees from any and all liability, claims, demands, actions and causes of action which I may hereafter have on account of any and all injuries and damage to me or to my property, or my death, arising out of or related to any happening or occurrence while I am participating in the academy. For the same consideration, I agree to forever hold the City of New Albany and said persons harmless from any such liability, claims, demands, action or causes of action.

    The terms hereof shall be in full force and effect during the period of my participation in the New Albany Citizen Police Academy.

    Please use your mouse, touch pad, or touchscreen to sign inside the box below.

    Applicant Signature:
  • I do hereby authorize a review of/and full disclosure of all records concerning myself to any authorized agent of the New Albany Police Department, whether the said records are of public, private, or confidential nature.

    The intent of this authorization is to give my consent for full and complete disclosure of any and all records concerning any criminal activity. This may include, but is not limited to, criminal histories, driving records, traffic accidents, arrest reports, offense reports, or any official documents.

    I understand that any information obtained by a background investigation which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for participating in the Citizen Police Academy. I certify that any persons who may furnish such information concerning me shall not be held accountable for giving this information; and I hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information.

    I authorize the release of my name and full disclosure of all records concerning myself to verify past and future applications with other law enforcement agencies.



    Please use your mouse, touch pad, or touchscreen to sign inside the box below.

    Applicant Signature:
  • I hereby certify that there are no willful falsifications, omissions, or misrepresentations in the foregoing statements and answers to questions. I understand that my omission or false statement on this application shall be sufficient cause for rejection for enrollment or dismissal from the New Albany Citizen Police Academy.

    I understand the information contained in this application is considered a public record and may be released to the media or others upon their request. I also understand that I may be photographed or videotaped by the news media or the New Albany Police Department during the course of this program. These pictures or videotapes will be used for news releases and informational promotions.

    Some classes require walking and standing as different facilities will be used or toured. Please inform us of any considerations or accommodations that you may need while at these facilities.

    Please use your mouse, touch pad, or touchscreen to sign inside the box below.

    Applicant Signature:
  • MM slash DD slash YYYY