Respect For Law Camp Application-2026

FORT MYERS POLICE DEPARTMENT

Police Athletic League

Respect For Law Camp Application June 11th to June 14th, 2026
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
FemaleMale
Address*

Address

Street Address Line 2

CityStateZipState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
School*
Grade*
YesNo
Platoon Leader Request
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List any unusual conditions the Camp Director should be aware of:*
Insurance Carrier
Medications*
Policy Number
EMERGENCY CONTACT INFORMATION: This person must be available to receive the call and respond within twenty to thirty minutes to the property. This person will take responsibility for your child from the campus should there be a need for your child to leave.
Emergency Contact*

First NameLast Name
Phone Number*
Relationship*
Emergency Contact

First NameLast Name
Phone Number
Relationship
If I cannot be reached, I hereby give permission for emergency treatment or surgery as recommended by the attending physician. As a parent or guardian, I will assume all responsibility for medical costs incurred by the applicant. I also permit the use of my child's likeness in camp promotional publications and release the city of Fort Myers Police Department from any liability that may arise due to participation.
Parent/Guardian Signature*
Parent/Guardian Name*

First NameLast Name
Date

MonthDayYear
Date
Application MUST be received 10 days prior to the opening of camp. No Refunds for cancellations received within 10 days of the opening of camp.

WARNING: This weekend will require participation in physical activities including marching and push-ups.

Make checks payable to: Respect for Law Camp

Mail to: Fort Myers Police Department 2210 Widman WayFort Myers, Florida 33901

Questions? Please call: Kassandra Gonzalez at (239)470-0802 OR email: kgonzalez@fortmyers.gov

City of Fort Myers Police Department Parental Consent
I hereby give my son/daughter Childs Name* permission to attend the Fort Myers Police Department Respect For Law Camp to be conducted on June 11, 2026-June 14,2026. I acknowledge the fact that the Law Camp is designed for children between ages 10-14.
I understand that the "Respect For Law Camp" participants will stay at Paul Lawrence Dunbar Middle School.
I understand that the activities are carried out under the direction or sponsorship of employees of the City of Fort Myers Police Department and other law enforcement agencies, schools.
I am aware of the nature of this program and I hereby assume responsibility for myself and/or my child to participate. I will not hold the City of Fort Myers or any agency connected with the Respect For Law Camp including, but not limited to any other law enforcement agency, school or Paul Lawrence Dunbar Middle School, or their employees responsible in case of an accident, injury or death as a result of participation in this camp.
I hereby agree to indemnify the City of Fort Myers from any and all liability arising out of any accident or death as a result of my child's participation in the Fort Myers Police Department/Police Athletic League, Respect For Law Camp.
This form must be in the possession of the City of Fort Myers Police Department prior to the registered person's participation in this program or the child will not be allowed to participate. NO EXCEPTIONS.
Date*

MonthDayYear
Date
Signature*
Multi Media Release
Known all men by these presents,
That I, Parent/Legal Guardian* , as a parent or legal guardian forChild* , hereby release authority to the Fort Myers Police Department or any agency it authorizes to photograph, record, tape or videotape said child. Furthermore, said child's photograph, identity, voice or videotaping is hereby deemed free of copyrights, royalties, or fee and may be duplicated or used in promoting future Fort Myers Police Department Respect For Law Camps.
Furthermore, no media, printed or electronic may be sued for the publication or broadcast of the photograph, tape, record or videotape of said child or child's identity.
Date *

MonthDayYear
Date
Signature*

Dress Code
Shirts:

Any shirt that covers the shoulders (t-shirts,polo shirt, button up shirts are OK) and does not advertise any inappropriate subjects (alcohol, tobacco, etc.). No "A" style, muscle shirts or cap sleeves.

Pants/Shorts:

Clothing must fit appropriately- no oversized clothing. Bermuda-style and denim shorts or pants are appropriate pants and shorts that have belt loops must be belted and worn at the waist. Shorts should fall JUST ABOVE THE KNEE.

-All Black attire is not allowed.

Footwear:

"Sneakers" are acceptable. No flip-flops, sport sandals, or open toe and open back shoes.

Sleepwear:

Appropriate clothing for going to and from the showers is required.

Any camper who is wearing clothing that the staff deems inappropriate will be asked to change. If suitable clothing is not available or cannot be brought to the the camper, the camper will be asked to leave the camp.
Signature*
Name*

First NameLast Name

Registration Payment*
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Respect For Law Camp Registration
$125.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Rows	1	2	Every 4-6hrs as needed	Do Not Administer
Tylenol
Ibuprofen
Benadryl
Pepto-Bismol

FORT MYERS POLICE DEPARTMENT

Police Athletic League

Respect For Law Camp Application June 11th to June 14th, 2026

Consent For Medical Treatment/Dispensing of Medication

City of Fort Myers Police Department Parental Consent

Multi Media Release

Dress Code