Kentucky State Police Youth Academy Program

Kentucky State Police Youth Academy Program
Youth Applicant Information
Applicant Name:*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:*

MonthDayYear
Date
Age:*
Sex:*

MaleFemale
Email Address:*
example@example.com
Applicant Cell Phone:*
High School Attending:*
Extracurricular Activities:*
T-Shirt Size: (Sizes Cannot Be Changed)*

SMLXLXXL
Parent/Guardian/Emergency Contact
Parent/Guardian(s) Name:*
Cell Phone:*
Home Phone:
Emergency Contact Name:*
Cell Phone:*
Home Phone:

Media Release
Do we have permission for pictures and videos of your child taken during program activities to be published in local newspapers and used for future Kentucky State Police Youth Academy promotions, articles, and social media accounts such as Facebook, X (Twitter), Instagram, and Youtube. All participants will be pictured in a Youth Academy Program group photo.*

YES, you have my permission for photos and videos to be used for the above purposes.NO, you do not have my permission for photos and videos to be used for the above purposes.
(Applicant Name)*
(Parental/Guardian Signature)*

Clear
Transportation
I hereby grant permission for the Kentucky State Police Youth Academy Program to provide transportation for my child, if needed.
(Applicant Name)*
(Parental/Guardian Signature)*

Clear

Consent to Participate

Parent's Consent/ Release from Liability
I, (parent or guardian)*
give my consent for my son/daughter
to participate in the Kentucky State Police's
Youth Academy Program.
I understand that they will be receiving training related to law enforcement topics, as well as taking part in supervised role-playing activities. Additionally, daily activities will include various physical fitness activities and swimming. All activities will be under direct supervision at all times.
If my son/daughter becomes ill or is injured during any activity, I understand that every reasonable effort will be made to contact me or a member of my family. If I cannot be reached, I understand that staff members will seek emergency medical care. I understand that notification efforts will be continued after medical care is sought.
I understand that should my son/daughter fail to follow any rules set forth by the Kentucky State Police and its staff or display disrespect or inappropriate behavior toward a camper or any staff member; those actions can result in dismissal from the Youth Academy Program.
I agree to indemnify, defend, hold harmless, and release the Commonwealth of Kentucky, Kentucky Justice Cabinet, Kentucky State Police, Kentucky State Police Trooper Island, their officers, employees, agents, and volunteers from any lawsuits, damages, claims, judgments, losses, liabilities or expenses arising out of the death, personal injury, or property damage involving my son/daughter, which may be sustained while participating in activities with the Kentucky State Police Youth Academy Program. All of the terms above shall apply whether or not caused by the alleged negligence, either active or passive, or any acts or omissions of the Commonwealth of Kentucky, Kentucky Justice Cabinet, Kentucky State Police, Kentucky State Police Trooper Island, their officers, agents, employees, or volunteers. I have read and fully understand this RELEASE FROM LIABILITY.
Signed,*

Clear
Date*

MonthDayYear
Date

APPLICATIONS WILL BE TAKEN ON A FIRST-COME BASIS AND MUST INCLUDE THE
FOLLOWING:
1. A 100-150 WORD ESSAY COMPOSED BY THE APPLICANT ON THEIR INTEREST IN KSP
AND A DESIRE TO ATTEND THE YOUTH ACADEMY PROGRAM
2. A RECOMMENDATION LETTER FROM ONE OF THE FOLLOWING:
a. TEACHER
b. PRINCIPAL
c. GUIDANCE COUNSELOR
d. SCHOOL RESOURCE OFFICER
e. KSP TROOPER
f. PASTOR
g. COMMUNITY LEADER
INSTRUCTION FOR PARENTS/GUARDIANS
1. Selection and notification to participants and their guardians will be emailed by June 27, 2025. The selection package will include additional instructions and details about the camp, such as directions, check-in and graduation times, and a packing list for participants.

2. If there are any questions, they may be directed to Trooper Scott Ferrell, Camp
Commander at (606) 776-9474 or by email at james.ferrell@ky.gov.

The Kentucky State Police is an equal opportunity employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, age,
national origin, veteran status, ancestry, sexual orientation, or disability
Graduation Ceremony RSVP
WHEN: Thursday, July 2nd, 2026
TIME: 11:00 A.M. CST
WHERE: Clinton County Early Childhood Center | 204 King Drive, Albany KY 42602
Number of Guest Attending Ceremony*

APPLICATIONS WILL BE TAKEN ON A FIRST-COME BASIS
AND MUST INCLUDE THE FOLLOWING (please upload below):

1. A 100-150 word essay composed by the applicant on their interest in KSP and a desire to attend the Youth Academy Program

2. A recommendation letter from one of the following:
a. Teacher
b. Principal
c. Guidance Counselor
d. School Resource Officer
e. KSP Trooper
f. Pastor
g. Community Leader
Upload Essay*

Cancelof
Upload Letter of Recommendation*

Cancelof
Should be Empty:

Kentucky State Police Youth Academy Program

Youth Applicant Information

Parent/Guardian/Emergency Contact

Medical Information

NON-PRESCRIPTION MEDICATION/AIDES

Media Release

Transportation

Consent to Participate

INSTRUCTION FOR PARENTS/GUARDIANS

Graduation Ceremony RSVP