Citizens Police Academy Registration

2. Universal City Police Department
   Citizens Police Academy Registration

4. Name*

6. Address*

8. City*

9. State*

10. Zip*

12. Company Name & Address (if not UC Resident)

14. Home Phone*

16. Cell Phone

18. Email

20. *Date of Birth (mm/dd/yyyy)*

22. *Driver's License or ID Card Number

24. 
    

26. Emergency Contact(s)

28. Name

30. Address

32. Phone Number

34. Relationship

36. 
    

38. Name

40. Address

42. Phone Number

44. Relationship

46. * This information is required for background checks and will be kept confidential.

48. 
    

50. How did you learn about the Citizens Police Academy?

Leave This Blank:


52. Submit

* indicates a required field