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REGISTRATION FORM Boynton Beach Police “TEEN ACADEMY” If you would like to attend an upcoming Teen Police Academy, Please complete this registration and mail to: Officer Rachel Loy Boynton Beach Police Department Crime Prevention Unit 100 East Boynton Beach Blvd. Boynton Beach, FL 33435 Please Print Child’s Name: Address:

Apt:

City /Zip: Home Phone:

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Cell Phone:

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Age / D.O.B. E-mail:

-Resident -Non Resident School Name Parent Name Parent Signature

NOTE: Registration must be received no later than July 1, 2014 •

• RETURN REGISTRATION ONLY Payment will be due after acceptance to program


Teen Police Academy Registration form