Please fill out the following form for the Winchester Police Department's one-day Citizen Academy held on November 16, 2019. Full Name * Given Middle name(s) Family Address * Home Phone Work Phone Cell Phone Email Address Birthday * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Year Drivers License # * Sex * Male Female Prefer not to say Height * Eye color * Hair color * Have you ever been arrested/convicted of a crime? If so, please explain. If you have not, please type "N/A" * Do you need special accommodations due to a disability? If so, please let us know. Terms & Conditions * Yes, I understand In consideration of the Winchester Police Department granting permission to enter in or upon any premises which are under actual care or passive control, I hereby waive all claims to damage or loss to my person or property which may be caused by any act or failure to act of the Winchester Police Department, its officers, agents or employees. I assume the risk of all dangerous conditions in or, upon the premises or vehicles, and waive any and all notice of existence of such conditions. I certify that I understand the requirements and responsibilities of participants in this program. Electronic Signature * Leave this field blank Submit Thank you! We'll be in contact soon.