Halton Regional Police Service
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Sgt. Dienstmann teaching the PEACE Program

PEACE Online Registration

1 - Personal Information

Given First Name:*
Date of Birth
House Number:*
Apartment Unit:
Street Name:*
City / Town:*
Postal Code:*
format: H0H 0H0
Contact Information
Phone - Home*
format: 905 555-5555
Phone - Cell

2 - Education

School Name:*
School Address:*
Highest Grade Completed:*

3 - Other Interests, Hobbies and Skills

4 - References

Name and Relationship:*
Address and Phone Number*

5 - Police Check

Due to the nature of this volunteer program, a police security check is necessary. Do you undertand and agree to have the check completed?:*

6 - Why You?

What does the PEACE Youth Leadership Program mean to you?
Why are you interested in the PEACE Youth Leadership Program?
What do you expect to gain from this experience?
Do you have any commitments that may interfere with this opportunity?
Have you ever had any contact with the police? If so, please describe this interaction - positive or negative.
What do you have to offer the PEACE Youth Leadership Program?

7 - Just so we Know

How did you hear about the PEACE Youth Leadership Program?

8 - Agreement to Terms and Conditions

I certify that the information contained in this application is true and complete to my knowledge. I understand that a false statement made throughout the entire slection process may disqualify me or cause my dismissal.  I am aware that as an applicant to the PEACE Youth Leadership Program with the Halton Regional Police Service. I may be required to answer questions related to age, offences, associations, etc for the purpose of conducting a security clearance.
I have read and agree to the Terms and Conditions stated above.