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Johns Creek Police Department

Dimitri.Caldwell@JohnsCreekGA.gov

Public Safety Academy Application

Johns Creek Public Safety Academy

Applicant Name

Applicant Address

T-shirt size (men)

T-shirt size (women)

Emergency Notifications

Emergency Contact Name

Background Information

Please upload a copy of your Georgia Driver's License (or government issued photo ID)

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By submitting this application, you (the applicant) hereby certify that there are no willful misrepresentations, omissions, or falsifications in the following statements and answers to questions. You (the applicant) understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Johns Creek Public Safety Academy.

You (the applicant) understand that, if selected for enrollment, you will pledge the time commitment to attend all Academy classes. You (the applicant) further understand that the Academy will be conducting a background investigation that may include, but not be limited to, any criminal history, driving record, and/or other personal references.

This class will be filled based on the order in which the completed applications are received.

Your signature (the applicant) below certifies that you (the applicant) have read and understand these completed pages, and agree to the terms and conditions outlined in this document. 

Release / Waiver

1. Due to the nature of defensive tactics/self-defense training, Johns Creek Police Department / Johns Creek Fire Department cannot be responsible for injuries incurred during physical training. Although all instructors will strive to prevent injuries in every way possible, we cannot control the human factor involved in such a program.

2. I, the undersigned, fully understand and acknowledge that my physical training is done at my own risk and tehreby relieve the Johns Creek Police Department / Johns Creek Fire Department, its management, and all instructors both collectively and individually of all responsobility and legal liability for injrueis incurred during physical training.

3. I, the undersigned, fully understand that many of hte techniques taught to me during this course are likely to cause serious physical injury and possible death when used effectively against another person or persons. I further understand that it is my responsibility to research and determine the legal justification, ramifications, and liability along with civil liability in my jurisdction. I pledge to use the techniques taught to me by the Johns Creek Police Department / Johns Creek Fire Department, only in a legal and responsible manner and only when it is necessary to protect myself or another.

4.I hereby acknowledge and agree that i have carefully read this waiver and release agreement, that I fully understand same, and that I am greely and voluntarily executing the same.

5. By signing this release, I will be forever prevented by suing or otherwise claiming against the Johns Creek Police and Fire Department for any property loss or personal injury that I may sustain whily participating in for the above noted activity.

6. I, the undersigned, give permission to the Johns Creek Police Department to video and photograph the class and these may be used by both department for our social media sites.

7. On this page, I will list any and all physical injuries or limitation. I have read and understand this form in its entirety.

 

Full Name

Date

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Important Note

Please complete the GCIC Criminal History form and have it notarized. Turn in the form at City Hall / JCPD Headquarters, 11360 Lakefield Drive.

 

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