NYPD
Official Use Only
Application Form
2016 Youth Police Academy
Attention: Parents & Guardians

This form MUST be completed in full and signed in ink below in order for your child to participate.
Incomplete applications will not be accepted.
PRINT CLEARLY or TYPE
Child’s Last Name (print clearly or type)
Child’s First Name (print clearly or type)
Address (print clearly or type)
Apartment Number
City (print clearly or type)
Zip Code:
N Y
Home Telephone Number:
Daytime Emergency Telephone Number
-
-
Child’s Date of Birth
/
-
-
Age
Female
Male
Month
Day
Year
Name of School Child currently attends
Check One
Child MUST be 10 years old by the start of the
program.
N Y
CITY HOUSING RESIDENT
YES
NO
Check One
Parent’s e-mail address
Child’s Shirt Size (Check One)
S
M
L
XL 2XL
A Separate Complete Application MUST Be Submitted For Each Child
If more than one of your children is applying to the Academy, please check this box 
In addition, please write the first and last names of each child you are registering below.
Additional Child:________________________________________
Additional Child: ________________________________________
Permission of the Parent or Guardian is Mandatory for Applicants
(Please Print) I, _________________________________________________________________ am the Parent/Guardian of:
(Print Child’s Full Name) ______________________________________________________ (hereinafter referred to as the CHILD), I
am over eighteen (18) years of age and reside at (Print Your Address)__________________________________________________.
Parent / Guardian – You MUST Sign Your Name in ink on the Line Below
(Application will not be accepted if not accompanied by Parent/Guardian signature)
In consideration of, and for the permission and authority of my CHILD to participate in the Youth Police Academy, which includes
classroom instruction, field trips, recreational events, sporting events and physical activities. I hereby release and forever discharge,
and shall hold harmless and indemnify the City of New York Police Department, the City of New York and its agents, servants and
employees (collectivity hereinafter referred to as the CITY) from all actions, causes of action, suits, debts, sums of money, accounts,
damages, judgments, claims and demands whatsoever which I or my CHILD, or our heirs, executors, administrators, successors and
assigns may have now or in the future against the CITY arising out of my Child’s participation in the Youth Police Academy
including, but not limited to the aforementioned activities and any acts related thereto. This release may not be changed orally.
Please Sign in Ink:
Please select an Academy Campus closest to your home. Check one box only!
The Academy meets Monday through Friday at the following locations:
 Bronx
Entrada Academy
977 Fox Street
Bronx, NY 10459
 Brooklyn South
Tilden H. S.
5800 Tilden Avenue
Brooklyn, NY 11203
 Queens North
I.S. 145
33-34 80th Street
Queens, NY 11372
 Bronx
Bronx Community College
2155 University Place
Bronx, NY 10453
 Brooklyn South
I.S. 14, (Shell Bank)
2424 Batchelder Street
Brooklyn, NY 11235
 Queens North
I.S. 204
36-41 28th Street
Queens, NY 11106
 Bronx
Mott Haven High Campus
730 Concourse Village West
Bronx, NY 10451
 Brooklyn North
I.S. 218
370 Fountain Avenue
Brooklyn, NY 11208
 Brooklyn North
Boys & Girls H.S
1700 Fulton Street
Brooklyn, NY 11213
 Queens South
 Queens South
J.H.S. 231
P.S./M.S. 43
145-00 Springfield Boulevard 160 Beach 29th Street
Queens, NY 11413
Far Rockaway, NY 11691
 Manhattan South
 Manhattan North
P.S. 111
George Washington HS
440 W. 53rd Street
549 Audubon Avenue
New York, NY 10019
New York, NY 10040
 Staten Island
Curtis H.S.
105 Hamilton Avenue
Staten Island, NY 10301
 Staten Island
New Dorp H.S.
465 New Dorp Lane
Staten Island, NY 10306
Summer Youth Police Academy 2016
POLICE DEPARTMENT CITY OF NEW YORK
COMMUNITY AFFAIRS BUREAU
The New York City Police Department seeks to provide innovative and effective programs for the City’s young people.
The Community Affairs Bureau’s, Youth Police Academy, is such a program. It is designed to establish a positive
relationship between the Police Department and the City’s youth.
New York City residents, attending school, between 10 and 16 years old are eligible to attend.
The goals of the academy are:



To enhance responsible citizenship.
To provide positive interaction with police officers and to educate young people about the challenges and
responsibility of police work.
To encourage young people to take part in other youth programs offered by the Police Department such as: the
Law Enforcement Explorers, Police Cadet Corps and the Police Athletic League.
The 2016 Youth Police Academy is a six (6) week program that will hold sessions five (5) days a week. The Academy
will open at 8:30 a.m. (morning), and dismissal will be at 2:00 p.m. (afternoon). Students will attend classroom sessions
with lectures, role-plays and demonstrations by police officers in the areas of law, behavioral science, drug prevention,
gang resistance, and life skills. Field trips are also part of the curriculum. Transportation to and from the field trips will be
provided. Each site is accessible by public transportation. Student should wear comfortable athletic attire and sneakers. A
uniform shirt, baseball style cap, carry bag and water bottle will be provided. Lunch will be provided daily.
The Academy will begin on Tuesday, July 5th and end on Friday, August 12TH, 2016
ENROLLMENT IS FOR A LIMITED TIME ONLY!
To apply for this year’s Youth Police Academy, complete and sign the application and mail it to the address below.
You will be contacted if your child is accepted. Please provide clear and accurate contact information.
Preference will be given to youth applicants who have not previously attended the academy.
Applications are to be submitted by Friday, May 20th, 2016.
Mail application to:
N.Y.P.D. Youth Services Section
YPA 2016
151 Lawrence Street
Brooklyn, NY 11201