Register for Paducah Citizens' Academy

First Name *

Middle Name *

Last Name *

Date of Birth *

Month

Day

Year

Phone Number (best one to reach you) *

E-mail *

Street Address (home) *

City *

State *

Employer Name and Address (if employed) *

How many years have you lived in this area? *

What is your t-shirt size? *

Do you have any dietary restrictions? *

Why are you interested in attending the Paducah Citizens' Academy? *

Background Check Permission *

I hereby grant permission for the City of Paducah to conduct a criminal history background check prior to my admission into the Paducah Citizens’ Academy. Please note that if you are under the age of 18, additional parental consent will be required.

Yes