Thank You for Your Submission

2. Were you impressed with the professionalism, dedication or willingness to go above and beyond from a member of the Champlin Police Department? If so, please take a moment to let us know.  This form helps us track compliments and ensure they are passed on to those you are commending. While some of these fields are not required, please provide at least an email address or phone number so we are able to contact you if we have questions or would like more information for official recognition.

4. First Name
5. Last Name
7. Phone Number
8. Email Address
10. Address
12. City
13. State
14. Zip Code
18. Officer or Staff Name (if known)
19. Badge Number (if known)
21. Does your commendation involve more than one officer or staff member?
23. Date and Time
    Date and Time

    Date and Time
24. Location of Event
26. Details
28. Do you have a photo, artwork or document related to this event?
29. Additional photos, artwork or documents related to this event?
33. Electronic Signature Agreement

    Photo/Artwork Release*

    We ask that you allow us to use your uploaded photo, artwork or other documentation in our publications, videos or social media to call out the great work by Police staff. 

    This is optional. If you agree, please read the below and submit electronic signature.

    The photo or artwork must have been taken/created by you or you have full legal rights to it. Children's artwork submitted by parents or legal guardians qualifies.

    I hereby authorize the City of Champlin to use the photograph(s) or original artwork(s). I hereby authorize the City of Champlin, its agents and employees to use these photographs in any current or future publication for news, advertising, or promotion purposes; in videos; on its website(s); or in any other media. I understand I will not be credited or compensated for use of the photographs or artwork.

    Public Data Advisory*

    The information you provide on this form is considered public record by law and would be released upon request pursuant to the Minnesota Government Data Practices Act. The information you provide can be accessed by others in accordance with the Data Practices Act.

    1. I have read and agree to the Photo / Artwork Release.
    2. I have read and understand the Public Data Advisory.
35. Electronic Signature
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field