LPD Junior Police Academy Form

2026 LPD Junior Police Application
Parent or guardian: Please complete one application for each teen who will be attending the program in 2026.
Parent/Guardian Information
Parent/Guardian name

First NameLast Name
Parent/Guardian address

Street Address

Street Address Line 2

City

Zip Code
Home phone
Format: 000-000-0000.
Cell phone
Format: 000-000-0000.
Parent/Guardian email address

Confirmation Email
Student's Information
Student name

First NameMiddle NameLast Name
Same address as above?
Student address

Street Address

Street Address Line 2

City

Zip Code
School / Grade
Enter name of last school attended and grade completed
Any Food Allergies or Medical Conditions that LPD needs to be aware of?
Age
T-shirt size
Emergency Contact Information
Emergency contact #1 - Name
Relationship #1
Example: parent, grandparent, friend, etc.
Emergency phone #1
Format: 000-000-0000.
Emergency contact #2 - Name
Relationship #2
Example: parent, grandparent, friend, etc.
Should be Empty:

2026 LPD Junior Police Application