Celina Fire Junior Academy Registration Form

Celina Fire Junior Academy Registration Form

Please fill out the form below to register for the Fire Academy program.
Student Full Name*

First NameLast Name
Parents Name

First NameLast Name
Person picking up child
Age
School attending
T-shirt size
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
List any medical conditions, allergies, medications, or special needs child has:
Should be Empty: