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Citizens on Patrol Application

  1. Palestine Police Department Logo

  2. Palestine Police Department

    Citizens on Patrol


  3. Citizens on Patrol patch

  4. Persons wanting to become a member of the Citizens On Patrol (COPs) Program must meet the following criteria:

    1. Be at least 21 years of age
    2. Submit a completed and approved COP application to the appropriate COP Coordinator by posted deadline prior to attending a COP training course.
    3. Pass CJIS and a background check
    4. Complete the 4 hour COP training course
    5. Possess a valid driver's license (to be able to conduct vehicle patrols)
    6. Ensure their vehicle(s) meet all Texas Motor Vehicle Code legal requirements: -vehicle registration, inspection, proof of vehicle insurance (to be able to conduct vehicle patrols)
  5. 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.


  7. Have you ever used a maiden/previous name?*
  8. Enter Maiden or Previous Name

  9. Enter Previous Name if Applicable

  10. Enter Previous Last Name if Applicable

  11. Have you ever used an alias?*
  12. Is your mailing address the same as your residential address?*
  13. Required for Background

  14. Required for Background

  15. Personal  Information




    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.

  20. Release of Liability Participation in the Citizens on Patrol-Palestine*

    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.

  21. I have read and understood this release*

    and signed it voluntarily and with full knowledge of its significance.

  22. Electronic Signature Agreement*

    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.


  24. Consent for storing submitted data*
  25. (Revised August 5, 2021)

  26. Leave This Blank:

  27. This field is not part of the form submission.