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2. The following is an application to participate in the Farmington Police Department's Community Learning / High School Senior Project Program. Please fill out the application completely. If a field does not apply to you, type N/A in the box. This program includes a ride-along. A separate application is NOT required as questions pertaining to the ride-along are included.
4. Today's Date*
5. Applicant's Name (First, Middle, Last)*
7. Date of birth*
8. Social Security Number*
9. Email*
11. Home Address*
    Street, City, State, Zip Code
13. Home Phone*
14. Place of Employment (if applicable)
16. Work Address
    Street, City, State, Zip Code
17. Work Phone
19. What school are you fulfilling hours for?*
20. Number of HoursRequired*
21. Date Hours Due By*
23. Instructor's Name*
24. Instructor's Phone Number*
26. Goals*
    Briefly describe your goal in participating in FPD's Community Learning / High School Senior Project. What do you hope to learn?
28. Contact with law enforcement*
    Briefly describe any contacts you've had with officers of the department in the last five years. (victim/suspect of crime, traffic ticket, accident, etc.)
30. Date of your last ride-along (if applicable)
31. Ride-Along Participant Requirements and Rules*

    1. Yes

    1. No

    I have received a copy of the Ride-Along Participant Requirements and Rules (located in PDF form on ride-along web page) and will comply with its contents.
33. Participant Name*
    By providing my electronic signature, I am certifying that the information I provided in this application is accurate.
34. Date*
36. Before participating in any activities with the Farmington Police Department, I acknowledge and affirmatively state that I: 1. Am fully aware that police activities can involve some danger and that I have a responsibility to carefully obey and follow all instructions given me by department employees and to exercise my own considered judgement to protect my safety during these activities. 2. Am in good health and physical condition and that I have fully revealed any health or physical limitations to the department through its employees. 3. Will not participate in any activity until I am sure I understand the instructions and am fully physically and mentally prepared to engage in this activity. 4. RELEASE the City of Farmington and its employees and agents from any liability or claim arising from damage or injury to me or my personal property arising from or occurring during any activities with the Farmington Police Department. 5. Have not participated in a ride along program in the past twelve months, except as provided in Farmington Police Department policy #299-05.
38. Executed on this date*
    Month, day, year
40. Participant Name*
    Electronic Signature
42. TO BE USED IF PARTICIPANT IS A MINOR
44. I am the parent or guardian of the participant signing above. I hereby give my permission for the participant to participate in activities with the Farmington Police Department. I understand some risk is involved in these activities. However, in consideration for the opportunity of the participant to experience and learn from these activities, I hereby RELEASE the City of Farmington, its employees and agents from any liability or claim arising from damage or injury to the participant or his or her personal property arising from or occurring during these activities.
46. Parent or Guardian*
    Electronic Signature
47. Date*
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field