Thank you for your interest in the Yankton Police Department Ride-Along Program. Please fill out this questionnaire and the Release of Liability Form. Once completed, submit both documents to the Yankton Police Department for consideration.

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Name

 *

Name

Last

First

Middle

Date of Birth

 *

Date of Birth

Phone

 *

Phoneext.

Email

 *

Email

Have you been convicted of a felony within the last seven years?

 *

Have you been convicted of a felony within the last seven years?

Yes

No

If yes, explain

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