Fairborn Citizens Police AcademyRegistration Application Name:Address:City:Zip:Email Address:Date of Birth:Drivers License #:State:OccupationNote: A Criminal Background Check is required as part of the application process. I authorize the release of any and all information to the Fairborn Police Department related to any criminal record or driving record. Further, I release any and all persons, institutions, corporations, governmental agencies, the Fairborn Police Department, its officers, executives, and employees, individually and in their official capacities from any and all liability that may arise from researching my background or from my participation in the Citizens Police Academy. Terms of Acceptance and Signature I, the applicant for this registration form, warrant the truthfulness of the information provided in this application. Electronic Signature: Date: I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.