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San Marcos Fire Department Citizens Fire Academy Application

2. 

3. San Marcos Fire Department Citizens Fire Academy Application
   Citizens Fire Academy is fun and informative for the citizens working or living in the City of San Marcos to see what it’s like to live and train as a firefighter. This free, fun academy is to help inform participants on the way San Marcos Fire Department operates and the ultimate goal is to learn fire safety. There is no cost to attend this fun class. Space is limited as there are only 15 seats available. Citizens Fire Academy (CFA) runs every Monday evening and a few Saturdays at Fire Station #5, 100 Carlson Circle from 6 p.m. to 9 p.m. (excluding holidays), for twelve weeks from mid-August to graduation night in early November.

   Citizens Fire Academy is fun and informative for the citizens working or living in the City of San Marcos to see what it’s like to live and train as a firefighter. This free, fun academy is to help inform participants on the way San Marcos Fire Department operates and the ultimate goal is to learn fire safety. There is no cost to attend this fun class. Space is limited as there are only 15 seats available. Citizens Fire Academy (CFA) runs every Monday evening and a few Saturdays at Fire Station #5, 100 Carlson Circle from 6 p.m. to 9 p.m. (excluding holidays), for twelve weeks from mid-August to graduation night in early November.

5. 1 Application Per Adult

9. PART 1: APPLICATION

11. First Name*

12. Last Name*

13. Goes by/Likes to be called:

15. Home Street Address*

17. City*

18. State*

19. Zip*

21. Date of Birth*
    Date of Birth

22. Gender*
    -- Select One --MaleFemale

23. Cell Phone Number*

    *Primary Contact Direct Number

25. Email Address*

    *Primary Form Of Communication

26. T-Shirt Size*
    -- Select One --Adult SmallAdult MediumAdult LargeAdult XLAdult XXL Adult XXXL

30. Do you either live or work in the City of San Marcos?*

    1. Yes

    1. No

32. Name of Employer*

33. Occupation*

35. Employer Address

37. City

38. State

39. Zip Code

43. Emergency / Alternative Contact*

    First and Last Name

44. Relationship*

45. Phone Number*

47. Health Information: Health Conditions*

    Please list any health conditions that will require special accommodations. If none, please write None.

49. Health Conditions: Medicine*

    Please list any medicines that your child regularly takes that will require special accommodations or administering while at JFA. If none, please write None.

51. Health Conditions: Food Allergies*

    Please list any food allergies that will require special accommodations. If none, please write None. Food Allergies may require you to provide your own meal.

55. How did you hear about Citizens Fire Academy? *

57. What is your purpose for attending? *

    Why do you want to participate in CFA?

61. Have you ever been arrested for or convicted of a crime? *

    1. Yes

    1. No

62. Do you currently have any charges filed against you that are either being tried or are pending in any criminal court? *

    1. Yes

    1. No

64. If you answered "Yes" to either of the questions above, please explain below:

66. Initials*

67. APPLICATION VALIDITY
    I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application will be cause for rejection for enrollment or dismissal from the San Marcos Citizens Fire Academy. I understand that a rejection of enrollment may occur if I have any charges filed against me that are currently being tried or are pending in any criminal court.

    I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application will be cause for rejection for enrollment or dismissal from the San Marcos Citizens Fire Academy. I understand that a rejection of enrollment may occur if I have any charges filed against me that are currently being tried or are pending in any criminal court.

69. Initials*

70. Background Check
    I understand that SMFD will run a background check as part of the application process.

    I understand that SMFD will run a background check as part of the application process.

74. Personal Reference #1*

    First and Last Name

75. Relationship*

76. Phone Number*

78. Personal Reference #2*

    First and Last Name

79. Relationship*

80. Phone Number*

84. Initials*

85. MINIMUM AGE AGREEMENT
    I, the undersigned, certify that I am at least EIGHTEEN (18) years old. I understand that falsification of any information on this form may disqualify me from the program.

    I, the undersigned, certify that I am at least EIGHTEEN (18) years old. I understand that falsification of any information on this form may disqualify me from the program.

87. Initials*

88. CFA MEETING TIMES
    I understand the Citizens Fire Academy runs for 12 weeks every Monday evening at Fire Station #5, 100 Carlson Circle from 6 p.m. to 9 p.m. (excluding holidays), from mid-August to graduation night in early November.

    I understand the Citizens Fire Academy runs for 12 weeks every Monday evening at Fire Station #5, 100 Carlson Circle from 6 p.m. to 9 p.m. (excluding holidays), from mid-August to graduation night in early November.

90. Initials*

91. FUTURE CFA COMMITMENT
    I understand that there is no charge for the Academy and, if selected for enrollment, pledge the time commitment to attend, and will volunteer 4 hours to Open House (October) and/or and Pancakes with Santa (December).

    I understand that there is no charge for the Academy and, if selected for enrollment, pledge the time commitment to attend, and will volunteer 4 hours to Open House (October) and/or and Pancakes with Santa (December).

93. Initials*

94. PERMISSION TO PHOTOGRAPH:
    As part of Citizens Fire Academy, a group photo will be taken and placed in local newspapers. There may also be media coverage of the academy as well as video to be used by the Fire Department. I authorize the photography for this purpose.

    As part of Citizens Fire Academy, a group photo will be taken and placed in local newspapers. There may also be media coverage of the academy as well as video to be used by the Fire Department. I authorize the photography for this purpose.

98. Legal First and Last Name*

    By typing my name, I am electronically signing this application. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

99. Date *
    Date

    Date

103. PART 2: RELEASE FROM LIABILITY FORM
     RELEASE FROM LIABILITY FORM

     To finalize your application, the following form will need to be turned in. This form needs to be printed and notarized. The original notarized form will need to be turned into SMFD Administration to complete your application. You may drop off or mail.

105. Mail in the original
     You may mail the original to San Marcos Fire Department Attn: Citizens Fire Academy 630 E Hopkins St. San Marcos, TX 78666

     You may mail the original to San Marcos Fire Department Attn: Citizens Fire Academy 630 E Hopkins St. San Marcos, TX 78666

106. Drop Off Original
     To drop of the original, bring the original form to the SMFD Administrative Office located at San Marcos Fire Station #5 100 Carlson Circle San Marcos, TX 78666.

     To drop of the original, bring the original form to the SMFD Administrative Office located at San Marcos Fire Station #5 100 Carlson Circle San Marcos, TX 78666.

110. PRINT THE RELEASE FROM LIABILITY FORM AND SUBMIT YOUR PART 1 OF YOUR APPLICATION
     Administration will finalize your application when we receive the physical, notarized copy of the Part 2: Release From Liability Form.

     Administration will finalize your application when we receive the physical, notarized copy of the Part 2: Release From Liability Form.

112. ADMINISTRATIVE USE ONLY

     1. Yes
     2. No

     ADMINISTRATIVE USE ONLY Has the original, notorized Release from Liability form been received?

113. DATE RFL FORM WAS RECEIVED
     DATE RFL FORM WAS RECEIVED

Leave This Blank:


114. 1. Receive an email copy of this form.
115. Email address

     This field is not part of the form submission.

116. Submit Submit and Print

* indicates a required field