HomeMy WebLinkAboutCPA Media Waiver 2020Johnson County
CITIZEN’S POLICE ACADEMY
Media Waiver
I, ____________________________________(participant name) have been
accepted to attend the 2020 Johnson County Citizen’s Police Academy. In an
attempt to promote future participation in the Johnson County Citizen’s Police
Academy, local media may be on sites taking photos, videos and interviewing
participants throughout the length of the JCCPA.
PLEASE CHECK THE APPRORIATE BOX BELOW AND SIGN/DATE
YES, I agree to the use of my photo/video/interview for current or future use
(circle all that apply)
NO, I do not want to be photographed, videoed, or interviewed
(circle all that apply)
_________________________________________________________________________________
Signature Date
PLEASE RETURN SIGNED FORM WITH YOUR APPLICATION.