Junior Firefighter Registration Form

Augusta Fire Rescue Junior Firefighter Program Application
Applicant Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
Age:*

1617
Applicant E-mail:*
example@example.com
Applicant Phone Number:*
Current School:*
Current Grade:*
Why do you want to become a Junior Firefighter?*
What interests you most about Firefighting?*
We are hoping to run this program weekly on alternating Monday and Tuesday nights from June to November:*

I am available weekly alternating Monday and Tuesday nightsI am only available Monday nightsI am only available Tuesday nightsI am not available these nights and would prefer another night.Other
Signature of Applicant:*

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Date
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Phone Number: *
Please enter a valid phone number.
Parent/Guardian Email:
example@example.com
I, the undersigned, give my permission for my child to participate in the Junior Firefighter program. I understand that there may be physical activities involved and assume any and all risks associated with such activities.
Parent/Guardian Signature: *

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Augusta Fire Rescue Junior Firefighter Program Application