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The City of Madison Heights Citizens' Academy Application

  1. To the best of our ability applicants will be selected to represent different geographical areas of the City.

    The academy needs to have a minimum of 15 applicants to justify the staff time, materials and other costs related to the academy. If 15 applicants are not received the academy may be postponed until 15 are received. Maximum participants 25. NOTE: A person that has prior or pending criminal investigations out of the City of Madison Heights will not be eligible to participate in the Citizen’s Academy.

  2. Would be able to commit to attending all 8 sessions of the academy? The academy will be held on Wednesdays starting September 19th from 5:30 p.m. – approximately 7:30 p.m. *

  3. Type Full Name

  4. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance below.*

  5. In registering myself for this activity, I hereby release the City of Madison Heights of all liability for damages or injury sustained by myself while engaged in this activity, and I also authorize Madison Heights officials to utilize my photo, and video tape of my participation in this program for which I am registering for any and all promotional purposes. NOTE: A person that has prior or pending criminal investigations out of the City of Madison Heights will not be eligible to participate in the Citizen’s Academy.

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