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RETURN Application to: Officer R.A. Mebus, ICPD, 410 E Washington St, Iowa City, IA 52240
Office use only: Date Received_______________ Liability Waiver Returned/Signed_____________
Johnson County Public Safety
Leadership Academy Application 2015
Name____________________________________________
Address__________________________________________
City_________________________State_________________Zip_________Phone________________________
Date of Birth_______________Age______School_________________________Grade Entering_____________
Parent/Guardian Name__________________________________Email___________________________________
Address_____________________________________________
City_________________________State_______________Zip___________Phone__________________________
EMERGENCY CONTACT NAME_____________________________Relationship_________Phone_______________
Any Known Allergies or Food Allergies______________________________________________________________
Any Medical Condition(s)________________________________________________________________________
The Johnson County Public Safety Leadership Academy will be each day July 13-17 and will begin Day 1 at the ICPD, 410 E Washington St. Iowa City, IA, 52240
and each subsequent day at the ICPD Substation, 1067 Hwy 6 E, Iowa City, IA, 52240. The Academy will start at 9:00am each day and end at 3:00pm each day
(lunch included). Topics include: ICPD/ICFD Tour/ Overview, K9 Unit, Special Response Team, Crime Scene Investigation, JC Metro Bomb Squad, Fire Apparatus,
Fire Turnout Gear, CPR, 1st Aid (list not all inclusive subject to change) . Limited to 20 participants
RETURN Application to: Officer R.A. Mebus, ICPD, 410 E Washington St, Iowa City, IA 52240
Office use only: Date Received_______________ Liability Waiver Returned/Signed_____________