For children entering 3rd through 5th grades.

Student will not be released unless an authorized parent/caregiver is present to pick up the student. Emergency contacts listed below are also permitted to pick up the student.

I, ____________________________________, being a parent or legal guardian of _______________________________________, a child, for myself, my heirs and my personal representatives, herby agree to defend, indemnify, and save harmless Douglas County, its officers, agents, and employees, from any action brought by or on behalf of the above-named child arising out of the Sheriff’s Office Youth Academy Program. The consideration for my agreements herein is the County allowing said child to engage in this activity.

This release, or photocopy of same, when presented by an authorized representative of the Douglas County Sheriff’s Office, will constitute my consent and authority to examine and obtain copies and abstracts of records and to receive statements and information regarding:
School records, local police reports, driving records, and employment information. This shall be done with full knowledge and understanding that the Douglas County Sheriff’s Office may use, consider or disclose such information, statements, records, with the scope of their official duties and responsibilities.
The authorization is given in connection with a full background investigation being conducted relative to my application as a Law Enforcement Youth Academy participant with the Douglas County Sheriff’s Office.

I hereby grant the Douglas County Sheriff's Office (DCSO) permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the DCSO and will not be returned. I hereby irrevocably authorize the DCSO to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the DCSO's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I hereby hold harmless and release and forever discharge the DCSO from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. Student Name: __________________________________________________. I hereby certify that I am the parent or guardian of (student name) named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.