2. 
4. Daphne Citizens Police Academy Application -- “Learn more about how law enforcement serves the public.”
6. Name*
8. Address*
9. City, State*
10. Zip Code*
12. Date of Birth*
13. Sex*
14. Email Address*
16. Cell Number*
17. Home Phone (if different)
19. Driver's License Number*
20. Issuing State*
22. Occupation/Title*
23. Employer
25. Employer Address
26. Employer City, State
27. Employer Zip Code
29. Please provide two (2) contacts (family members or close friends) that we may reach in case of emergency:
31. Name*
32. Relationship*
33. Contact Phone*
35. Name*
36. Relationship*
37. Contact Phone*
39. Have you ever attended a Citizens Academy before?*

    1. Yes
    2. No
40. If Yes, please list where:
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field