Lebanon, TN Police Dept.

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Site Name

Lebanon Tennessee Police Department

Phone

(615) 444-2323

Tagline

Protect with Courage – Serve with Compassion

Youth Police Academy Application

Youth Police Academy Application

Youth Police Academy Application | Lebanon, TN Police Dept.
Student's First Name *
Student's Middle Name *
Student's Last name *
Parent/Guardian First Name *
Parent/Guardian Middle Name *
Parent/Guardian Last Name *
Street Address *
City *
State *
Zip Code *
Student's Phone Number *
Parent/Guardian Phone Number *
Email Address *
Date of Birth *
Current School Attending *
Grade *
Teacher, Adminitrator, Adult Friend Reference *
List any Medical/Physical Limitations/Allergies *
By checking the "I agree" box below, you agree to authorize the Lebanon Police Department to check your criminal history record in the process of your application. The Lebanon Police Department reserves the right to determine an applicant's eligibility based on information provided and background history check. All information is to remain confidential as required by state and federal statutes.
Criminal Background Check Agreement *
I Agree
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Electronic Signature Agreement *
I Agree
Enter your First Name, Middle Initial, and Last Name to sign electronically (First M. Last)
Student's Electronic Signature *
Parent/Guardian Electronic Signature *
Enter an email address below to send a copy of the email/submission of this form to that email address.
Email This Submission To (CC Email)
Please answer the security question below to verify that you are a real person.
What COLORS are in the United States of America Flag?
Answer


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