Please read and acknowledge the following
I certify that the information recorded on this application is correct. I agree to abide by the rules, policies, and regulations Lakes Region Mutual Fire Aid Association and New Hampshire Division of Fire Standards and Training if I am admitted as a student. Falsification of information may result in a denial of a course certificate. I hereby authorize release of any and all information concerning my enrollment in this course to the chief officer in charge or designee of my organization. All requests for information shall be in written form from said chief or designee.
I certify that the listed applicant is a member of the listed fire department/agency and is covered by Worker’s Compensation Insurance. Non-affiliated students shall provide proof of insurance.
I further certify that the listed applicant meets or exceeds prerequisites for this program, if applicable.