Citizen Fire Academy Application

  • Academy will be held April 23-May 21. Please check each box showing that you agree to the following conditions: * Required
  • Participant's Name * Required
  • This event is limited to adults age 18 and up.
  • Additional Participant's Name
  • This event is limited to adults age 18 and up.
  • Address * Required
  • Shirt Style * Required
  • Shirt Size
    In consideration of accepting my registration, I, on behalf of said group(s) release any and all rights and claims for damages we may have against the City of West Carrollton and its representatives, successors and assigns for any and all injuries suffered by myself and any guest of said group(s). I do hereby grant and give these groups the right to use a group photograph or image with or without names, both singly and in conjunction with other persons or objects for any and all purposes including, but not limited to private or public presentations, advertising, publicity and promotion relating thereto. I warrant that I have the right to authorize the foregoing uses and do hereby agree to hold the City of West Carrollton harmless of and from any and all liability of whatever nature which may arise out of result from such uses. For the consideration stated above, I further agree that in the event any person of said group(s) repudiates or attempts to repudiate such release, I will personally indemnify and save harmless the City of West Carrollton, its successors and assigns, for any and all loss and damage occasioned thereby.
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