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Citizen Fire Academy Application
Academy will be held April 9-May 7. Please check each box showing that you agree to the following conditions:
Minimum Age Requirement of 18 years old.
A criminal history check will be completed on each applicant. Applicants with a criminal record will be admitted upon approval of the Fire Chief.
Participants will be required to wear appropriate attire during training activities and ride-a-longs.
Participants will be required to conduct themselves in a professional manner at all times.
Participants will be required to sign a HIPPA nondisclosure.
Accepted participants will be notified of final approval to attend the academy.
Priority will be given to applicants who are current residents or work in the City of West Carrollton,
Applications must be received by 8 am March 29, 2019.
This event is limited to adults age 18 and up.
Address Line 2
State / Province / Region
ZIP / Postal Code
Please briefly explain why you want to participate in the West Carrollton Citizen Fire Academy.
Please provide some topics that you would like to see covered during your attendance.
Reference Phone Number
WAIVER FOR PARTICIPANT
I accept the terms of the waiver
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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