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NOTE: Applicants who have a Concealed Handgun License: COP members are not permitted to carry any type of a firearm with them while involved in any Citizens on Patrol activities.
Provide the names, addresses, and phone numbers of two references.
I hereby grant the Palestine Police Department permission to conduct a background investigation based on the information given on this application.
I agree to assume any and all liability and hold the Palestine Police Department, its officers, employees, and instructors harmless from all claims or actions which I ever had, now have, or may have in the future or any liability for injuries or damages which occur to me as a result of my participation in the Citizens on Patrol-Palestine. I expressly waive all claims for medical expenses, loss of services, or other claims to which I may otherwise be entitled, and I agree to indemnify and hold harmless the Palestine Police Department, its officers, employees, and instructors from all claims made by third parties against it or them which results from my activities with the Citizens on Patrol-Palestine.
and signed it voluntarily and with full knowledge of its significance.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
(Revised August 5, 2021)
This field is not part of the form submission.
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