St. Albert Citizen's Patrol Society

Application Form
Please PRINT CLEARLY
Before submitting this application form, call Nancy at
459-0519 to ensure that the Patrol operates in your area.
Fields marked with * are required.
Surname  *
Given Names  *
Birthdate  *
Gender  *
Former Name(s) 
Home Address  *
Postal Code  *
Email Address 
Residence Phone  *
Business Phone 
Emergency Contact 
Emergency Phone 
Length of Residency in St. Albert  *
Have You Ever Been Charged With A Criminal Offence?  *
If Yes, List Brief Details And Guilty Or Not Guilty 
Are You Currently In Good Health?  *
If No, Explain 


I give permission to the St. Albert R.C.M.P. to obtain all necessary information to qualify me as a volunteer for the Citizen's Patrol. I promise to read carefully, the guidelines and responsibilities handout provided by the Program if I am selected as a member. I hereby acknowledge that any false information given on this application will be grounds for non-acceptance and/or immediate dismissal.

Signature   Date    
Please return this application to:        RCMP ST. ALBERT   Fax (780) 458-7971
96 Bellerose Drive, St. Albert, Alberta T8N 7A4