Cop Scouts Registration

Cop Scouts Registration

University Circle Police Department
Student Information
Name*

First NameLast Name
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Primary Care Doctor*
Current Medications*
Allergies/Medical Concerns*
Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Cop Scouts Oath
As a Cop Scout with the University Circle Police Department, Iblanks* faithfully promise that:
1. I wil ALWAYS respect myself.
2. I will ALWAYS respect others.
3. I will ALWAYS respect my parents.
4. I will ALWAYS respect my teachers.
5. Schoolwork will ALWAYS come first.
6. I will make every effort to keep my grades up.
7. I will ALWAYS be a TEAM Player and help others.
8. I will NEVER laugh at others, but ALWAYS laugh with them.
9. I will NEVER use offensive language.
10. I will ALWAYS respect others' cultural and religious beliefs.
11. I will ALWAYS stay with my Buddy.
Student's Signature:*

Clear
Date*

MonthDayYear
Date
Consent, Assumption of Risk and Release of Liability for Participation in University Circle Police Department's "Cop Scouts" Program
AS A CONDITION OF AND IN CONSIDERATION OF participating in any and all activities associated with the University Circle, Inc. and University Circle Police Department's Cop Scouts Program (hereinafter referred to as "the Program"), this Consent, Assumption of Risk and Release of Liability is signed by me and undertaken by me as my own personal and voluntary decision, and if I am a minor, also by my parent or legal guardian.

1. I/we understand and acknowledge that University Circle, Inc. (hereinafter referred to as UCl) and University Circle Police Department (hereinafter referred to as UCPD), do not require any person to participate in the Program, and that my election to participate is my personal and voluntary decision.
2. I/we expressly acknowledge and understand that participating in the Program might be dangerous and could involve the risk of injury, permanent disability, damage to property and/or death. I affirm that I am aware of my physical condition and warrant and represent that I am fully able to participate in the Program and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit my participation in the Program.
3. WAIVER OF LIABILITY. I/we knowingly and freely assume all such risks associated with participating in the Program, both known and unknown, even if arising from negligence, and assume full responsibility for my participation. On behalf of myself, my heirs, assigns, personal representatives and next of kin, I/we hereby
RELEASE, DISCHARGE, COVENANT NOT OT SUE and HOLD HARMLESS UCI and UCPD, their employees, officials, officers and agents (hereinafter referred to collectively as "Releases") from any and all liability, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, that might arise from my participation in the Program, including but not limited to any and all injury, disability, death, loss of time, loss or damage to person or property or other side effects that may result from participation in the Program to the fullest extent permitted by law. The undersigned further expressly agrees that this Consent, Assumption of Risk and Release of Liability agreement is intended to be as broad and inclusive as is
permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I/WE HAVE READ THIS CONSENT, ASSUMPTION OF RISK, AND RELEASE OF LIABILITY AGREEMENT, AND I/WE FULLY UNDERSTAND ITS TERMS. I/WE UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I/WE SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name of Participant (print):*

First NameLast Name
Signature of Participant:*

Clear
Participant's Parent/Guardian Name, (if under 18):*

First NameLast Name
Signature of Parent/Guardian*

Clear
Date:*

MonthDayYear
Date
The University Circle Police Department regularly uses social media to highlight our activities, do you consent to having your Participant's photograph used in our promotional posts?*

YesNo
Should be Empty:

Cop Scouts Registration

Student Information

Parent/Guardian Information

Cop Scouts Oath

Consent, Assumption of Risk and Release of Liability for Participation in University Circle Police Department's "Cop Scouts" Program