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2. Name of Applicant*
4. Address1*
6. Address2
8. City*
9. State*
10. ZIP*
12. Name of Parents*
14. Home Phone*
16. Emergency Phone 1*
17. Emergency Phone 2*
19. Child's Age on June 1, 2015*
    Must be 10 or 11.
21. Sex*
22. Date of Birth*
    Date of Birth
23. Shirt Size*

    1. Small
    2. Medium
    3. Large
25. Name of School*
27. Good Conduct Endorsement by School Official
    Please have signed.
29. Pervious Police Camps attended?*

    1. Yes
    2. No
31. Return no later than June 1, 2015 to:

    Whitemarsh Township Police

    Attn: Sgt. Brian Mack

    616 Germantown Pike

    Lafayette Hill, PA 19444

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32. Print Only

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