KEY WEST FIRE Department Junior Firefighter Program Application

KEY WEST FIRE Department Junior Firefighter Program Application

Are you a motivated student looking to learn more about firefighting, emergency services, and teamwork? The Key West Fire Department is currently gauging interest for a Junior Firefighter Program! This program is designed for youth ages 14–17 who want to explore the fire service in a hands-on, safe, and educational environment. Participants will learn basic skills, attend training sessions, assist with department activities, and gain valuable leadership and teamwork experience. Please Note: This is not a formal application for membership. At this stage, we are collecting information to determine the level of interest and plan next steps accordingly.If you're interested in learning more or potentially joining the program, please complete the form below. We’ll be in touch with more details if the program moves forward
Participant Information

First NameLast Name
MonthDayYear
DOB
Phone Number Format: (000) 000-0000.
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information

First NameLast Name
Phone NumberFormat: (000) 000-0000.
Email
Emergency Contact

First NameLast Name
Relation
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
Primary Care Physician
Phone NumberFormat: (000) 000-0000.
Hospital
Medical Conditions (Please List)
Allergies (Please List)
Medications (Please List)
Background Information (Background check may be conducted)
Have you ever been arrested, ticketed, fined, etc? (Felonies, Traffic Tickets, Misdemeanors, etc) If Yes, Please list the date(s) and what the charge(s) were/was:
Additional Information
What interests you the most about becoming involved with the Key west Fire Department?
Please list other activities that you are involved in (Sports, Volunteer Work, Church, etc)
Applicant Signature
Parent Signature
Parental Consent
My son/daughter, First Name Last Name , has my permission to be a Junior Firefighter with the KEY WEST Fire Department. I give my consent to allow First Name Last Name to be a Junior Firefighter and do not hold the Key West Fire Department and First Responders for any actions caused by my son/daughter that is not under the direction of an Officer.
Junior Firefighter Signature
Parent/Guardian Signature
Contract of Understanding

I and my son/daughter have read ALL of the Junior Firefighter Guidelines and understand the guidelines set up to outline the purpose of the Junior Firefighters. I and my son/daughter understand that Junior Firefighters serve as supporters of the Key west Firefighters to learn the basics of Firefighting and to prepare to become a full member at the age of 18. I and my son/daughter understand that Junior Firefighters are to follow all instructions from members of the KWFD and that the general standard of conduct is to act in the manner of a professional. I and my son/daughter understand that he/she is expected to be courteous and respectful of other members (Junior and Regular) and to all citizens as they are representing the Key West Fire Department. I and my son/daughter understand there is a “zero tolerance” policy regarding drug and alcohol use. I and my son/daughter understand that by signing this Contract of Understanding we are declaring that any violation of the guidelines is grounds for immediate dismissal. I and my son/daughter understand that any acts that violate the guidelines and that are illegal by state law will be referred to the Dubuque County Sheriff’s Department.
Junior Firefighter Signature
Parent/Guardian Signature
KWFD Contact Info:

Lead Instructor: Dalton Kirk 563-213-2093 Daltonkirk@hotmail.com Secondary Instructor: Claire Siegert 563-542-5265 Clairesiegert@gmail.com Instructor: Hunter Egan 563-690-8154 Eganhunter99@gmail.com
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KEY WEST FIRE Department Junior Firefighter Program Application

Parental Consent

Contract of Understanding

KWFD Contact Info: