Police and Youth Together

Camper Agreement
For everyone to have a great experience at camp, please read and sign below:

 I will join in all the activities during the Police and Youth Together Camp.

 I will respect everyone, their belongings, and their space.

 I understand that if I don’t follow the rules, NCCJ will call my parent/guardian.

I have read and agree to the above.

I certify that the information provided is correct and complete so far as I (the undersigned) know, and the person
herein described as the student has permission to engage in all prescribed camp activities, on or off the camp property, except as noted on this health form. I understand that it is the
responsibility of the parent/guardian to inform The National Conference of Community and Justice of Greater
Dayton of any changes or additions to this form on the day the child arrives at camp. I also certify that the above-named camper has received a health exam from a licensed medical personnel within the past 24 months of time before the camper will be at camp. I have listed any physical condition requiring restrictions on participation in the camp program and a description of such restrictions. I have also listed any current or ongoing treatments or medications.

 I have read the application and give consent for my child to attend the 2026 Police and Youth Together Camp at Dayton Leadership Academies at 1416 W Riverview Ave, Dayton, OH 45402.

 I give NCCJ of Greater Dayton, RTA and participating Police Agencies to transport my child to and from PAYT at Dayton Leadership Academies and for scheduled follow-up sessions throughout the year.