TOWN OF RAMAPO YOUTH COURT
237 Route 59
Suffern, New York 10901
(845) 357-5100 Fax: (845) 357-3877
Email: youthcourt@ramapo.org
MICHAEL B. SPECHT BRAD R. WEIDEL
Supervisor Chief of Police
APPLICATION FOR MEMBERSHIP
To participate in Youth Court you must be at least 13 years old and a resident of the Town of Ramapo. Mail the completed
application and two references to the Town of Ramapo Youth Court office, 237 Route 59, Suffern, NY 10901.
NAME:________________________________________ DATE OF BIRTH:_____________________
ADDRESS:__________________________________________________________________________
TELEPHONE #:__________________________(home) _________________________________(cell)
EMAIL:___________________________________________
GRADE:_______ High School you are or will be attending:___________________________________
Parent or Guardian: ____________________________________________________
Address(if different) ____________________________________________________
____________________________________________________
Parent cell phone: ____________________________________________________
Parent’s email: ____________________________________________________
Extracurricular Activities: ____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Hobbies/Interests: ____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do you work: ______ If yes, where: ________________________________ How long:_____________
How did you hear about or become interested in the Youth Court: ______________________________
___________________________________________________________________________________
___________________________________________________________________________________
What qualities do you have that would make you a good Youth Court member: ___________________
___________________________________________________________________________________
___________________________________________________________________________________
Youth Court Membership Application
Page 2
What do you hope to gain from being in Youth Court: _______________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
What are your education or career plans after graduation from high school: _______________________
____________________________________________________________________________________
____________________________________________________________________________________
Have you ever been found guilty of a crime:________ If yes, what were the charges:________________
____________________________________________________________________________________
Have you ever been the victim of a crime: _________ If yes, please explain: ______________________
____________________________________________________________________________________
____________________________________________________________________________________
Emergency Contact:
Name:__________________________________ Relationship to Applicant: ______________________
Address: ___________________________________________________________________________
Phone Number: ___________________________ Email:_____________________________________
I hereby certify that the information set forth in the above application are truthful to the best of my
knowledge
___________________________________
Applicant’s Signature Date
Parental Permission: I give my consent to have my child participate in the Town of Ramapo Youth
Court.
___________________________________
Parent/Guardian Signature Date
NOTE: Please return application and reference forms together to Town of Ramapo Youth Court, 237
Route 59, Suffern, New York or by e-mail: youthcourt@ramapo.org.
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