Woodburn Police Department Community Police Academy

Name: *

Address *

City *

State *

Zipcode *

Home Phone *

Cell Phone *

Alternate Phone

Email *

Drivers License # *

State issued *

Emergency Contact Name and Relationship *

Emergency Contact Phone # *

If yes to either question, list dates, charges, locations, and a brief explanation. If no, write NA. *

Briefly explain: *

Briefly explain why you would like to participate in the Community Academy *

I certify that all the above information is true and complete. I understand that any misleading information rendered on this application may be cause for denial of registration of the class. I hereby authorize Woodburn Police Department or its designees to make such investigations and inquiries of information contained in this application, of but not limited to, my driving record and/or crimingal history as may be necessary. My entered name in the space below constitutes my signature and acknowledges that I have completed this application to the best of my knowledge and I have read and understand the conditions as stated on this application. *

Signature of Applicant (Please enter your full name)

COMMUNITY ACADEMY LIABILITY WAIVER

The above field purposely left blank. Do NOT enter information.

Name (First, Last) *

Maiden *

SSN *

Signature of Applicant (Please enter you full name) *

COMMUNITY ACADEMY RELEASE AND HOLD HARMLESS AGREEMENT

The above field purposely left blank.

I understand that I will be a student of the Woodburn Police Community Academy and have not been offered any payment from the Police Department, the City of Woodburn, or its employees for the opportunity to participate in the program. My participation is completely voluntary and for my own educational benefit. At all times during my participation in the academy program, I agree to obey all orders, instructions and commands of the officer(s) and instructors of the Woodburn Police Department. I fully realize and appreciate the basic nature of law enforcement and the possibility that situations may arise which might result in my exposure to dangerous activities and the hazards connected therewith, including the risk of physical harm, injury, or death, and I am willing to accept these risks. I also understand that I may be a passenger in vehicles operated by Woodburn Police Officers, and understand that I will be a guest and not a passenger for hire or other consideration while riding in such vehicles. As a part of my participation in the academy program, I agree to keep confidential anything which I may observe or hear. I understand that my participation in the Citizen’s Academy may be terminated at any time without notice. I further understand that through my enrollment in this program, I may be summoned as a witness in any proceeding as a result of my observations. In consideration of being permitted to participate in the Woodburn Police Department Citizen’s Academy and receive the training provided, to include scenarios, live firearm and simulated firearm training, and possibly ride in a vehicle owned and operated by the City, I agree to assume the full risk of any and all injuries, death, damages, or loss as a result of said participation. I further agree to release and hold harmless the City, its agents, employees, and elected official from any and all liability to me for personal injury or death or any property damage, whether proximate or remote, sustained during or as a result of my participation as a Community Academy student. I authorize the Police Department to conduct a complete records check of me prior to my participation in the Community Academy and understand that any information of an adverse or criminal nature may disqualify me. I agree that the Police Department and City of Woodburn may use, reproduce, disclose, and distribute my name, picture and/or likeness for City marketing purposes in relation to my participation in the Community Academy.

The above field purposely left blank. Do NOT enter information.

Signature of Applicant (Please enter you full name) *

Woodburn Police Department Community Police Academy

2026 Registration Form

Contact Information