2015 Teen Police Academy Boynton Beach Police Department Registra on Form
If you would like to a end the upcoming Teen Police Academy, please complete this form en rely and return to: Officer Rachel Loy Boynton Beach Police Department 100 E Boynton Beach Blvd, Boynton Beach FL 33435 561‐742‐6849 PLEASE PRINT Teen’s NAME:________________________________________________________________ Teen’s AGE and DATE OF BIRTH:_____________________ Teen’s GENDER:_______________ Teen’s RACE: ______________ Teen’s ADULT SHIRT SIZE (S, M, L, XL, 2XL):_______________ Teen’s ADDRESS:______________________________________________________________ ____________________________________________________________________________ Teen’s SCHOOL and UPCOMING GRADE:___________________________________________ Parent’s NAME:_______________________________________________________________ Parent’s SIGNATURE:___________________________________________________________ Parent’s CONTACT NUMBER:____________________________________________________ Parent’s EMAIL:_______________________________________________________________ *** REGISTRATION MUST BE RECEIVED BY JULY 1, 2015*** Return Registra on Form Only Payment will be due a er acceptance to program