Women's Safety Series

Registration for the January 2022 session is currently full. Please check back later for additional offerings.

Questions? Contact Officer Keppler.

Women's Safety Series Registration Form

First Name*

Middle Name/Initial*

Last Name*

Address*

Date of Birth*

Driver's License Number*

State the Driver's License was Issued From*

Email Address*

Phone Number*

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Address*

Emergency Contact Phone Number*

Are you 18 years or older?*

Yes

Photography Waiver

I give permission for my picture to be used in advertisements for the Huntley Police Department. These photographs may be used in, but not limited to, local print media, on the Village of Huntley’s website, social media, and in future displays/brochures.

I have read and agree to the Photography Waiver*

Yes

Permission to Conduct a Background Investigation

As an applicant of the Huntley Police Department Women’s Safety Series, I hereby authorize the Huntley Police Department to conduct a criminal history background investigation. I understand that all available police and criminal records will be checked and that information will be used in determining eligibility of applicants. Applicants with felonies, certain misdemeanor and/or traffic offenses or those who have been arrested by the Huntley Police Department may not be eligible to participate.

I have read and agree to the Permission to Conduct a Background Investigation*

Yes

Waiver of Liability

In consideration of my participation in the Huntley Police Department Women’s Safety Series Defensive Tactics Training, I understand and acknowledge that I will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from my own actions, inactions, or negligence, but the actions, inactions, and/or negligence of others, the rules of play, and the condition of the premises or of any equipment used. I further understand and acknowledge that there may be other risks of participation in the Women’s Safety Series Defensive Tactics Training that is not known and cannot be reasonably foreseen at this time. I hereby assume all the foregoing risks and accept personal responsibility for the damages following such injury, disability, or death. Therefore, I do hereby relieve, release, absolve, and hold harmless the Village of Huntley, its officers, employees, and agents of and against any liability or loss which may arise, should any injury or damage be sustained by the named participant, or others, as a result of my participation in the Women’s Safety Series Defensive Tactics Training pursuant to the established rules and procedures for the Women’s Safety Series Defensive Tactics Training unless arising out of the gross negligence or failure to follow appropriately established procedure by the Village of Huntley, its officers, employees, and agents. This release shall be binding on my legal representatives, heirs, and assigns.

I have read and agree to the Waiver of Liability*

Yes