In-service Registration Step 1 of 3 - Student Information 0% First / Last Name*Rank*Date of Birth:* Home Address*City*State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code:* Name of Course:*Start Date* End Date* Agency InformationName of Agency:PhoneChief or Designee Authorizing Enrollment:*Chief or Designee Email Address:* Must check both boxes.* * I am a law enforcement officer. * * My Chief has approved this course. IN-COUNTY TUITION: No Fee OUT-OF-COUNTY TUITION: Listed on each In-Service Training Catalog Course Description. In Consideration for and as a strict condition of my participation in this training activity, I, the Registrant, do hereby release all rights, claims, demands, and/or other causes of action I may have against the Camden County College Police Academy, the Camden County Prosecutor’s Office, and the Camden County Board of Chosen Freeholders, their officers, employees and agents, as well as the individual instructors of this course and their respective employers, for any type of personal injury, property or other damage claim that I may suffer as a consequence of my participation in this class or event. This is to certify that the above-enrolled personnel are protected for both workers’ compensation and liability coverage under my employer’s insurance or self-insurance program. A certificate of insurance outlining this coverage shall be furnished upon request. This waiver does not affect any rights I may have existing under state law to make a claim for Worker’s Compensation. After submission, confirmation will be sent to the Chief of Police or his or her designee. CommentsThis field is for validation purposes and should be left unchanged.